POURNAWATTIE ANDREA CHANDRADATT


Address: 7936 Portland Ave S, Bloomington, MN 55420-1315
Phone: 7636008613

POURNAWATTIE ANDREA CHANDRADATT (NPI# 1972162527) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1972162527
Entity Type Individual
Full Name POURNAWATTIE ANDREA CHANDRADATT
Credential DDS
Practice Address 7936 Portland Ave S
Bloomington
MN 55420-1315
Mailing Address 15769 Wyoming Ave
Savage
MN 55378-6627
Practice Telephone 7636008613
Mailing Telephone 6128037113
Enumeration Date 2019-06-07
Last Update Date 2019-06-07
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223G0001X Dentist
Specialization: General Practice
D14249 MN Dental Providers

Office Location

Street Address 7936 PORTLAND AVE S
City BLOOMINGTON
State MN
Zip Code 55420-1315

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Taxonomy Information

Taxonomy Code 1223G0001X
Grouping Dental Providers
Classification Dentist
Specialization General Practice

Taxonomy Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Notes: Source: Academy of General Dentistry

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Competitor

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City BLOOMINGTON
Zip Code 55420

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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