Provider Demographics
NPI:1598983801
Name:CHUDASAMA, DIPAK NANALAL (BDS, MSC, MORTH RCS)
Entity Type:Individual
Prefix:DR
First Name:DIPAK
Middle Name:NANALAL
Last Name:CHUDASAMA
Suffix:
Gender:M
Credentials:BDS, MSC, MORTH RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 DESEO
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3409
Mailing Address - Country:US
Mailing Address - Phone:904-864-2638
Mailing Address - Fax:
Practice Address - Street 1:6939 DESEO
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3409
Practice Address - Country:US
Practice Address - Phone:904-864-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253171223X0400X
FLDN 189411223X0400X
NY054803-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics