Provider Demographics
NPI:1255528360
Name:CHANDRAKEERTHI, CHIRDEEP MYSORE (BDS, MSD)
Entity type:Individual
Prefix:DR
First Name:CHIRDEEP
Middle Name:MYSORE
Last Name:CHANDRAKEERTHI
Suffix:
Gender:M
Credentials:BDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7032 E COCHISE RD A220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253
Mailing Address - Country:US
Mailing Address - Phone:480-443-8440
Mailing Address - Fax:480-443-4767
Practice Address - Street 1:7032 E COCHISE RD A220
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253
Practice Address - Country:US
Practice Address - Phone:480-443-8440
Practice Address - Fax:480-443-4767
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90201223P0300X
GADN0153351223P0300X
AZ105581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics