Provider Demographics
NPI:1477819365
Name:CHANDRAN, MONICA PAREKH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:PAREKH
Last Name:CHANDRAN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18121 GEORGIA AVE
Mailing Address - Street 2:STE. 110
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1437
Mailing Address - Country:US
Mailing Address - Phone:240-454-5718
Mailing Address - Fax:
Practice Address - Street 1:18121 GEORGIA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1437
Practice Address - Country:US
Practice Address - Phone:240-454-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055685-1122300000X
MD151181223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist