Provider Demographics
NPI:1336349257
Name:CHANDESH, AISHWARYA KUMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:AISHWARYA
Middle Name:KUMAR
Last Name:CHANDESH
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 1:816 TRAVIS ST APT F65
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7147
Mailing Address - Country:US
Mailing Address - Phone:972-814-0485
Mailing Address - Fax:
Practice Address - Street 1:816 TRAVIS ST APT F65
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7147
Practice Address - Country:US
Practice Address - Phone:972-814-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0136011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice