Provider Demographics
NPI:1043485287
Name:TIRUVEEDULA, CHITRA (BDS,DDS)
Entity Type:Individual
Prefix:DR
First Name:CHITRA
Middle Name:
Last Name:TIRUVEEDULA
Suffix:
Gender:F
Credentials:BDS,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26831 ALISO CREEK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5341
Mailing Address - Country:US
Mailing Address - Phone:216-548-6543
Mailing Address - Fax:949-362-8525
Practice Address - Street 1:26831 ALISO CREEK RD STE 202
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5341
Practice Address - Country:US
Practice Address - Phone:949-362-8523
Practice Address - Fax:949-362-8525
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.25951223G0001X
MND122761223G0001X
CA644821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice