Provider Demographics
NPI:1063984656
Name:CHAUDHARY, ABHISHEK
Entity type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:
Last Name:CHAUDHARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FNU
Other - Middle Name:
Other - Last Name:ABHISHEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11120 STOCKDALE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3680
Mailing Address - Country:US
Mailing Address - Phone:661-665-0080
Mailing Address - Fax:
Practice Address - Street 1:740 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3352
Practice Address - Country:US
Practice Address - Phone:661-665-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist