Provider Demographics
NPI:1568879831
Name:GUNDECHA, SHANUP CHAND (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANUP
Middle Name:CHAND
Last Name:GUNDECHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 EMERY LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-6111
Mailing Address - Country:US
Mailing Address - Phone:919-633-1577
Mailing Address - Fax:
Practice Address - Street 1:2525 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1062
Practice Address - Country:US
Practice Address - Phone:919-633-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No122300000XDental ProvidersDentist