Provider Demographics
NPI:1831351881
Name:HOLUR YAMANNA, CHITRA (DDS)
Entity type:Individual
Prefix:
First Name:CHITRA
Middle Name:
Last Name:HOLUR YAMANNA
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 1:430 W ERIE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6914
Mailing Address - Country:US
Mailing Address - Phone:312-274-0308
Mailing Address - Fax:
Practice Address - Street 1:4828 COLUMBIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1011
Practice Address - Country:US
Practice Address - Phone:214-823-0202
Practice Address - Fax:214-824-6464
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice