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NPI Code Detail

MEDICARE: DR. RAVI CHANDRAN DMD PHD FACS

MEDICARE: DR. RAVI CHANDRAN DMD PHD FACS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)DN122555GA

General Provider Information

NPI Number : 1043496235
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAVI CHANDRAN DMD PHD FACS
Provider Business Mailing Address
First Line : 2386 CLOWER ST STE 100
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-6134
Country : US
Telephone Number : 770-979-9500
Fax Number : 770-493-4900
Provider Business Practice Location Address
First Line : 2386 CLOWER ST STE 100
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-6134
Country : US
Telephone Number : 770-979-9500
Fax Number : 770-493-4900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2008
Last Update Date : 06/03/2026

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