Provider Demographics
NPI:1548356736
Name:WALIA, CHANDAN S (DDS)
Entity type:Individual
Prefix:DR
First Name:CHANDAN
Middle Name:S
Last Name:WALIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20652 N 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9309
Mailing Address - Country:US
Mailing Address - Phone:917-913-9143
Mailing Address - Fax:
Practice Address - Street 1:3800 W RAY RD STE B6
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5940
Practice Address - Country:US
Practice Address - Phone:917-913-9143
Practice Address - Fax:480-407-6533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022672031223P0300X
NY0502521223P0300X
AZD 77381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ537911Medicaid