Provider Demographics
NPI:1710313697
Name:CHAUDHARI, DIPAK (DDS)
Entity Type:Individual
Prefix:
First Name:DIPAK
Middle Name:
Last Name:CHAUDHARI
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 1:4148 BALBOA DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1638
Mailing Address - Country:US
Mailing Address - Phone:310-621-4466
Mailing Address - Fax:
Practice Address - Street 1:4148 BALBOA DR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1638
Practice Address - Country:US
Practice Address - Phone:310-621-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist