Individual
GANGADHARA CHANDU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 RED BROOK BLVD, OWINGS MILLS, MD 21117-5172
(312) 121-2222
Mailing address
400 RED BROOK BLVD, OWINGS MILLS, MD 21117-5172
(312) 121-2222
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
44444444444444444444
IA
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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