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General NPI Number Information
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NPI Number | 1548356736
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Entity Type | Individual
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Provider Name | CHANDAN S WALIA D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 3800 W RAY RD STE B6
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City | CHANDLER
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State | AZ
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Zip | 85226-5940
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Country | US
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Telephone | 917-913-9143
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Fax | 480-407-6533
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Provider Business Mailing Address
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Address Line | 20652 N 53RD AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-9309
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Country | US
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Telephone | 917-913-9143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22D102267203
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 050252
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D 7738
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License Number State | AZ
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