Provider Demographics
NPI:1023071396
Name:CHANDRASHEKHAR, SUMATHI (DMD)
Entity type:Individual
Prefix:DR
First Name:SUMATHI
Middle Name:
Last Name:CHANDRASHEKHAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SUMATHI
Other - Middle Name:
Other - Last Name:RAMASWAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 FOREST BEND DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2039
Mailing Address - Country:US
Mailing Address - Phone:214-218-5543
Mailing Address - Fax:
Practice Address - Street 1:5017 TEASLEY LN STE 165
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-3895
Practice Address - Country:US
Practice Address - Phone:214-218-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04965811223G0001X
NJ22DI021690001223G0001X
CA560551223G0001X
TX314261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01357611Medicaid