Provider Demographics
NPI:1629288857
Name:CHINNAM, VASAVI REDDY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:VASAVI
Middle Name:REDDY
Last Name:CHINNAM
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 1:2840 PARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2866
Mailing Address - Country:US
Mailing Address - Phone:831-688-0555
Mailing Address - Fax:831-475-5740
Practice Address - Street 1:2840 PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2866
Practice Address - Country:US
Practice Address - Phone:831-688-0555
Practice Address - Fax:831-475-5740
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist