Provider Demographics
NPI:1396812939
Name:CHADDA, HARVINDER S (B DS)
Entity type:Individual
Prefix:
First Name:HARVINDER
Middle Name:S
Last Name:CHADDA
Suffix:
Gender:M
Credentials:B DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 DUNLAWTON AVE
Mailing Address - Street 2:STE F
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4222
Mailing Address - Country:US
Mailing Address - Phone:386-767-5417
Mailing Address - Fax:386-767-6611
Practice Address - Street 1:790 DUNLAWTON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-767-5417
Practice Address - Fax:386-767-6611
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist