Basic Information
| Provider Information | |||||||||
| NPI: | 1740265503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADVANI | ||||||||
| FirstName: | CHANDAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 WORCESTER RD | ||||||||
| Address2: | APT #622C | ||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017025453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178754267 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 250 MOUNT VERNON ST | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021253120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172881140 | ||||||||
| FaxNumber: | 6172883910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 21141 | MA | Y | Dental Providers | Dentist |
No ID Information.