Healthcare Provider Details

I. General information

NPI: 1386571974
Provider Name (Legal Business Name): ADYA CHAURASIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19591 W INDIAN SCHOOL RD STE 101
BUCKEYE AZ
85396-2096
US

IV. Provider business mailing address

6450 W LAWRENCE LN
GLENDALE AZ
85302-4456
US

V. Phone/Fax

Practice location:
  • Phone: 602-830-3837
  • Fax: 602-814-0957
Mailing address:
  • Phone: 503-739-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012716
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: