Provider Demographics
NPI:1770839136
Name:BANDARUPALLI, CHAITANYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:
Last Name:BANDARUPALLI
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 1:40745 CHILTERN DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3703
Mailing Address - Country:US
Mailing Address - Phone:408-332-4273
Mailing Address - Fax:
Practice Address - Street 1:43693 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5832
Practice Address - Country:US
Practice Address - Phone:510-651-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist