Healthcare Provider Details

I. General information

NPI: 1487742094
Provider Name (Legal Business Name): HARINDERPAL SINGH CHAHAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PALISADES DR SUITE 210
ALBANY NY
12205-6433
US

IV. Provider business mailing address

5 PALISADES DR SUITE 210
ALBANY NY
12205-6433
US

V. Phone/Fax

Practice location:
  • Phone: 518-348-0634
  • Fax:
Mailing address:
  • Phone: 518-348-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number23119
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12011777A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6853-15
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: