Provider Demographics
NPI:1407368707
Name:KALAVACHARLA, VAMSI KRISHNA (DDS)
Entity Type:Individual
Prefix:
First Name:VAMSI
Middle Name:KRISHNA
Last Name:KALAVACHARLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 RAMSEY ST STE 8
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2130
Mailing Address - Country:US
Mailing Address - Phone:910-716-0105
Mailing Address - Fax:
Practice Address - Street 1:4251 RAMSEY ST STE 8
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-2130
Practice Address - Country:US
Practice Address - Phone:910-716-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV69761223G0001X
NC108961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty