Basic Information
Provider Information
NPI: 1508171158
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOOPALLY
FirstName: CHAITANYA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.D.S
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4030 ALAN DR
Address2:  
City: LARGO
State: FL
PostalCode: 337715208
CountryCode: US
TelephoneNumber: 2482294970
FaxNumber:  
Practice Location
Address1: 206 NE 7TH AVE
Address2:  
City: AMARILLO
State: TX
PostalCode: 791075214
CountryCode: US
TelephoneNumber: 8889884066
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/06/2010
LastUpdateDate: 08/06/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X0025787TXY Dental ProvidersDentist 

No ID Information.


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