Provider Demographics
NPI:1972824225
Name:CHAVDA, MADHAVI (DMD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:CHAVDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HIGH RIDGE HOLW
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3247
Mailing Address - Country:US
Mailing Address - Phone:920-624-2832
Mailing Address - Fax:
Practice Address - Street 1:780 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1665
Practice Address - Country:US
Practice Address - Phone:860-232-6865
Practice Address - Fax:860-216-4957
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT102711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice