Provider Demographics
NPI:1689746711
Name:WADHWANI, CHANDUR PK (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:CHANDUR
Middle Name:PK
Last Name:WADHWANI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 BEL-RED RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2627
Mailing Address - Country:US
Mailing Address - Phone:425-453-1117
Mailing Address - Fax:425-462-1878
Practice Address - Street 1:12715 BEL-RED RD.
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2627
Practice Address - Country:US
Practice Address - Phone:425-453-1117
Practice Address - Fax:425-462-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA100281223P0700X
WADE000100281223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics