Healthcare Provider Details

I. General information

NPI: 1609353499
Provider Name (Legal Business Name): PRACHI CHANDALIA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E MONROE AVE
ALEXANDRIA VA
22301-3020
US

IV. Provider business mailing address

3299 K ST NW APT 702
WASHINGTON DC
20007-4450
US

V. Phone/Fax

Practice location:
  • Phone: 703-341-4418
  • Fax:
Mailing address:
  • Phone: 202-322-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401416177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: