Provider Demographics
NPI:1336318658
Name:TUMMALA, CHIRANJEEVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHIRANJEEVI
Middle Name:
Last Name:TUMMALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 CONWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2609
Mailing Address - Country:US
Mailing Address - Phone:713-667-6151
Mailing Address - Fax:
Practice Address - Street 1:5411 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4001
Practice Address - Country:US
Practice Address - Phone:713-723-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38846183500000X
TX0022894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No183500000XPharmacy Service ProvidersPharmacist