MEDICARE: DR. CHITRAVATHI GUNDAPPA D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	26549	TX

General Provider Information

NPI Number	:	1831384395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHITRAVATHI GUNDAPPA D.M.D.

Provider Business Mailing Address
First Line	:	811 E 32ND ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2507
Country	:	US
Telephone Number	:	512-306-0601
Fax Number	:	512-306-8522

Provider Business Practice Location Address
First Line	:	811 E 32ND ST
Second Line	:	100
City	:	AUSTIN
State	:	TX
Zip	:	78705-2507
Country	:	US
Telephone Number	:	512-306-0601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	05/01/2015

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