Provider Demographics
NPI:1326361866
Name:CHIGURUPATI, KAVITA
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:CHIGURUPATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAVITA
Other - Middle Name:
Other - Last Name:CHIGURUPATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS, MSD
Mailing Address - Street 1:1500 FAIRVIEW AVE E
Mailing Address - Street 2:STE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3727
Mailing Address - Country:US
Mailing Address - Phone:206-325-7456
Mailing Address - Fax:206-323-6273
Practice Address - Street 1:1500 FAIRVIEW AVE E
Practice Address - Street 2:STE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3727
Practice Address - Country:US
Practice Address - Phone:206-325-7456
Practice Address - Fax:206-323-6273
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist