Provider Demographics
NPI:1386861904
Name:CHIRU, NEELIMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEELIMA
Middle Name:
Last Name:CHIRU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NEELIMA
Other - Middle Name:
Other - Last Name:BANDARUPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2260 NORTHLAKE PARKWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-492-0250
Mailing Address - Fax:770-492-0750
Practice Address - Street 1:2260 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4036
Practice Address - Country:US
Practice Address - Phone:770-492-0250
Practice Address - Fax:770-492-0750
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist