Provider Demographics
NPI:1619319662
Name:RAVAL, CHAITANYA H (DDS)
Entity Type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:H
Last Name:RAVAL
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 1:1107 S MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-3827
Mailing Address - Country:US
Mailing Address - Phone:630-815-9633
Mailing Address - Fax:
Practice Address - Street 1:1107 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3827
Practice Address - Country:US
Practice Address - Phone:630-815-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15487122300000X
TX337091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist