Provider Demographics
NPI:1104272301
Name:CHOUDHRY, VARUNA
Entity type:Individual
Prefix:
First Name:VARUNA
Middle Name:
Last Name:CHOUDHRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 N TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1281 MISSISSAUGA ROAD
Practice Address - Street 2:
Practice Address - City:MISSISSAUGA
Practice Address - State:ONT
Practice Address - Zip Code:L5H2J1
Practice Address - Country:CA
Practice Address - Phone:647-881-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist