Healthcare Provider Details

I. General information

NPI: 1083986533
Provider Name (Legal Business Name): RAMAKIRAN VENKATA CHAVALI B.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CAHABA RIVER PARC
BIRMINGHAM AL
35243-3250
US

IV. Provider business mailing address

SDB 603 1919 7TH AVE S UNIVERSITY OF ALABAMA BIRMINGHAM SCHOOL OF DENTISTRY
BIRMINGHAM AL
35294-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-514-5667
  • Fax:
Mailing address:
  • Phone: 205-975-9722
  • Fax: 205-975-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number27371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: