Provider Demographics
NPI:1588423313
Name:SHUKLA, CHANDANI HARISH
Entity type:Individual
Prefix:DR
First Name:CHANDANI
Middle Name:HARISH
Last Name:SHUKLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 W BOSAL DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5279
Mailing Address - Country:US
Mailing Address - Phone:626-673-4686
Mailing Address - Fax:
Practice Address - Street 1:9301 E SHEA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6735
Practice Address - Country:US
Practice Address - Phone:480-767-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0118231223X0400X
CADDS1114811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics