Provider Demographics
NPI:1629364153
Name:GARRAWAY, CHINARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHINARA
Middle Name:
Last Name:GARRAWAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 GOVERNORS SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3049
Mailing Address - Country:US
Mailing Address - Phone:850-792-1074
Mailing Address - Fax:
Practice Address - Street 1:6672 THOMASVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-4142
Practice Address - Country:US
Practice Address - Phone:850-203-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN193831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice