Provider Demographics
NPI:1902036056
Name:CHANDER, KAVITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:CHANDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KAVITA
Other - Middle Name:
Other - Last Name:CHANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:909 CHANNEL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-5613
Mailing Address - Country:US
Mailing Address - Phone:423-834-4321
Mailing Address - Fax:
Practice Address - Street 1:921 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2102
Practice Address - Country:US
Practice Address - Phone:423-209-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1902036056Medicaid