Provider Demographics
NPI:1629484530
Name:CHADDA, MONISHA MANISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONISHA
Middle Name:MANISH
Last Name:CHADDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 INDIAN TRL
Mailing Address - Street 2:NONE
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1626
Mailing Address - Country:US
Mailing Address - Phone:248-703-6287
Mailing Address - Fax:
Practice Address - Street 1:3777 INDIAN TRL
Practice Address - Street 2:NONE
Practice Address - City:ORCHARD LAKE
Practice Address - State:MI
Practice Address - Zip Code:48324-1626
Practice Address - Country:US
Practice Address - Phone:248-703-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist