Provider Demographics
NPI:1013601574
Name:CHAUDHARI, GANESH PRASAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:GANESH
Middle Name:PRASAD
Last Name:CHAUDHARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5212
Mailing Address - Country:US
Mailing Address - Phone:773-797-2000
Mailing Address - Fax:
Practice Address - Street 1:3346 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5212
Practice Address - Country:US
Practice Address - Phone:773-797-2000
Practice Address - Fax:773-797-2000
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist