Gangadhara Chandu
Individual provider Active NPI Dental Assistant · Owings Mills, MD
NPI 1821375809 · NPPES record last updated Nov 4, 2011
Key facts
- NPI
- 1821375809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Assistant 126800000X
- License
- 44444444444444444444 (IA)
- Practice address
- 400 Red Brook Blvd
Owings Mills, MD 21117-5172 - Phone
- (312) 121-2222
- NPI assigned
- Nov 4, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44444444444444444444 | IA | MD | Dental Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 44444444444444444444 | IA | Yes |
Addresses
Primary practice location
400 Red Brook Blvd
Owings Mills, MD 21117-5172
Mailing address
400 Red Brook Blvd
Owings Mills, MD 21117-5172
Phone (312) 121-2222
Other providers in Owings Mills, MD
- Centers for Advanced Orthopaedics, LLC
- Centra Healthcare System
- Centrepointe Counseling, Inc.
- Gail Isabel Chambers
- Briana Chandler
- Andrea Chaney
- Diane Isaacson Charles
- Charm City Medical Equipment & Supplies, LLC.
- Charm City Therapy
- Mariam Chaudhri
All providers in Owings Mills, MD · Dental Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.