Provider Demographics
NPI:1023848066
Name:CHANDRASEKAR, BALAJI (DMD)
Entity type:Individual
Prefix:DR
First Name:BALAJI
Middle Name:
Last Name:CHANDRASEKAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4104
Mailing Address - Country:US
Mailing Address - Phone:321-945-1716
Mailing Address - Fax:
Practice Address - Street 1:3907 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5209
Practice Address - Country:US
Practice Address - Phone:407-228-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN294541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice