Provider Demographics
NPI:1457840928
Name:CHITRA TIRUVEEDULA,DDS A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:CHITRA TIRUVEEDULA,DDS A PROFESSIONAL DENTAL CORP
Other - Org Name:ADVANCED DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADVANCED
Authorized Official - Middle Name:
Authorized Official - Last Name:DENTAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-362-8523
Mailing Address - Street 1:26831 ALISO CREEK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5341
Mailing Address - Country:US
Mailing Address - Phone:949-362-8523
Mailing Address - Fax:
Practice Address - Street 1:26831 ALISO CREEK RD STE 202
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5341
Practice Address - Country:US
Practice Address - Phone:949-362-8523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64482261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherDENTAL OFFICE