Provider Demographics
NPI:1801356811
Name:CHIRRAVUR, PRAZWALA (BDS, MS)
Entity Type:Individual
Prefix:
First Name:PRAZWALA
Middle Name:
Last Name:CHIRRAVUR
Suffix:
Gender:F
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 NOTTINGHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1185
Mailing Address - Country:US
Mailing Address - Phone:832-331-2256
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-6110
Practice Address - Country:US
Practice Address - Phone:860-679-2925
Practice Address - Fax:860-679-4760
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13584125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersOral Medicinist