Pournawattie Andrea Chandradatt, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14249 Issued in MN

Practice address

7936 Portland Ave S
Bloomington, MN 55420-1315

Phone

(763) 600-8613

NPI assigned

Jun 7, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559865600000",
    "number": "1972162527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15769 WYOMING AVE",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "553786627",
            "telephone_number": "612-803-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7936 PORTLAND AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554201315",
            "telephone_number": "763-600-8613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDRADATT",
        "first_name": "POURNAWATTIE",
        "middle_name": "ANDREA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-07",
        "last_updated": "2019-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel D.K Chache
• Linda Chai, DPT
• Michelle Ann Chalupnik Rivera
• Kirsten Ann Chamberlin
• Katherine Champ
• Cher Chang
• Lian S Chang, M.D.
• Laura Chapeau, LISW
• Charles Blons, PLLC
• Anushka Chaudhari

• General Practice Dentistry in Bloomington, MN
• Providers in Bloomington, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.