Provider Demographics
NPI:1639661580
Name:RELIANT DENTIST PC
Entity Type:Organization
Organization Name:RELIANT DENTIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIRANJEEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-723-7200
Mailing Address - Street 1:5411 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4001
Mailing Address - Country:US
Mailing Address - Phone:713-723-7200
Mailing Address - Fax:713-728-0048
Practice Address - Street 1:5411 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4001
Practice Address - Country:US
Practice Address - Phone:713-723-7200
Practice Address - Fax:713-728-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty