Provider Demographics
NPI:1447268305
Name:CHAKKA, SEKHAR N (DDS)
Entity type:Individual
Prefix:
First Name:SEKHAR
Middle Name:N
Last Name:CHAKKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11897 FOOTHILL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-476-9678
Mailing Address - Fax:909-481-0040
Practice Address - Street 1:11897 FOOTHILL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-476-9678
Practice Address - Fax:909-481-0040
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice