MEDICARE: PRATIMA CHANDLER DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1588359764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRATIMA CHANDLER DDS PLLC

Provider Business Mailing Address
First Line	:	124 IVY HILLS TER
Second Line	:
City	:	PURCELLVILLE
State	:	VA
Zip	:	20132-6144
Country	:	US
Telephone Number	:	484-751-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 MADDEX DR
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-4322
Country	:	US
Telephone Number	:	484-751-4843
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	PRATIMA SHARMA CHANDLER
Credential	:	DDS
Telephone Number	:	484-751-8483

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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