MEDICARE: DR. PRACHI CHANDALIA DMD

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	1223P0221X	Pediatric Dentistry	0401416177	VA

General Provider Information

NPI Number	:	1609353499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRACHI CHANDALIA DMD

Provider Business Mailing Address
First Line	:	3299 K ST NW APT 702
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-4450
Country	:	US
Telephone Number	:	202-322-3392
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 E MONROE AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-3020
Country	:	US
Telephone Number	:	703-341-4418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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