Provider Demographics
NPI:1568777605
Name:BADDAM, CHETAN (DDS)
Entity Type:Individual
Prefix:
First Name:CHETAN
Middle Name:
Last Name:BADDAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 CAMPBELL AVE
Mailing Address - Street 2:2 L
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2037
Mailing Address - Country:US
Mailing Address - Phone:217-414-4234
Mailing Address - Fax:
Practice Address - Street 1:267 CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4405
Practice Address - Country:US
Practice Address - Phone:203-932-3700
Practice Address - Fax:203-932-3701
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice