Individual
DR. AGASTAYYA CHANDALADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
430 W ERIE ST, SUITE 200, CHICAGO, IL 60654-6914
(920) 838-1649
Mailing address
430 W ERIE ST, SUITE 200, CHICAGO, IL 60654-6914
(920) 838-1649
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS037917
PA
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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