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General NPI Number Information
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NPI Number | 1750080057
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Entity Type | Organization
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Legal Business Name | CHANDANA VUNDAVALLI DDS
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 2324 SANTA RITA RD STE 3
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City | PLEASANTON
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State | CA
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Zip | 94566-4150
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Country | US
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Telephone | 949-769-1971
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Fax |
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Provider Business Mailing Address
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Address Line | 4218 CHAPMAN WAY
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City | PLEASANTON
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State | CA
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Zip | 94588-3953
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Country | US
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Telephone | 949-769-1971
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHANDANA SANTHOSHI VUNDAVALLI
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Credential |
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Telephone | 949-769-1971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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