Provider Demographics
NPI:1447690136
Name:CHAINANI, OM G (DMD)
Entity type:Individual
Prefix:DR
First Name:OM
Middle Name:G
Last Name:CHAINANI
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 1:205 PORT RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1311
Mailing Address - Country:US
Mailing Address - Phone:718-727-2555
Mailing Address - Fax:
Practice Address - Street 1:205 PORT RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1311
Practice Address - Country:US
Practice Address - Phone:718-727-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057654122300000X
NJ22DI02541800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist