Provider Demographics
NPI:1962684415
Name:JAGADEESAN, CHITRAKALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHITRAKALA
Middle Name:
Last Name:JAGADEESAN
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 1:3 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3889
Mailing Address - Country:US
Mailing Address - Phone:860-977-5027
Mailing Address - Fax:
Practice Address - Street 1:778 BROAD ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-4619
Practice Address - Country:US
Practice Address - Phone:860-525-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT96381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice