Healthcare Provider Details

I. General information

NPI: 1033762414
Provider Name (Legal Business Name): TEJASVITA CHANDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE ST
PORTLAND ME
04103-2617
US

IV. Provider business mailing address

201 FEDERAL ST UNIT 1003
PORTLAND ME
04101-8110
US

V. Phone/Fax

Practice location:
  • Phone: 207-221-4747
  • Fax:
Mailing address:
  • Phone: 781-468-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDEN5277
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: