Provider Demographics
NPI:1831384395
Name:GUNDAPPA, CHITRAVATHI (DMD)
Entity type:Individual
Prefix:DR
First Name:CHITRAVATHI
Middle Name:
Last Name:GUNDAPPA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHITRA
Other - Middle Name:
Other - Last Name:PRADEEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:811 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2507
Mailing Address - Country:US
Mailing Address - Phone:512-306-0601
Mailing Address - Fax:512-306-8522
Practice Address - Street 1:811 E 32ND ST
Practice Address - Street 2:100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2507
Practice Address - Country:US
Practice Address - Phone:512-306-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice