Healthcare Provider Details

I. General information

NPI: 1740478049
Provider Name (Legal Business Name): ARPITHA MARRI D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WEST MAPLE ST APT 2001
CHICAGO IL
60610
US

IV. Provider business mailing address

111 W MAPLE ST APT 2001
CHICAGO IL
60610-5452
US

V. Phone/Fax

Practice location:
  • Phone: 312-560-4636
  • Fax:
Mailing address:
  • Phone: 312-560-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019025720
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: