Provider Demographics
NPI:1801617303
Name:CHAND, SHAYAL (DDS)
Entity type:Individual
Prefix:
First Name:SHAYAL
Middle Name:
Last Name:CHAND
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 1:1500 FOUNDERS POINT DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9056
Mailing Address - Country:US
Mailing Address - Phone:209-214-5034
Mailing Address - Fax:
Practice Address - Street 1:GREENHAVEN MODERN DENTISTRY 992 FLORIN ROAD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831
Practice Address - Country:US
Practice Address - Phone:916-221-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist