Provider Demographics
NPI:1912550690
Name:CHITTAL RAMACHANDRA REDDY LAKSHMI, DEEPTI (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTI
Middle Name:
Last Name:CHITTAL RAMACHANDRA REDDY LAKSHMI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DEEPTI
Other - Middle Name:
Other - Last Name:CHITTAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3020 39TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 39TH ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5548
Practice Address - Country:US
Practice Address - Phone:409-433-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice