Provider Demographics
NPI:1063003812
Name:CHITRA SHANMUGHAM, D.D.S., INC
Entity Type:Organization
Organization Name:CHITRA SHANMUGHAM, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANMUGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-871-9734
Mailing Address - Street 1:281 E HAMILTON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0232
Mailing Address - Country:US
Mailing Address - Phone:408-871-9734
Mailing Address - Fax:408-871-9734
Practice Address - Street 1:281 E HAMILTON AVE STE 2
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0232
Practice Address - Country:US
Practice Address - Phone:408-871-9734
Practice Address - Fax:408-871-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental