Healthcare Provider Details

I. General information

NPI: 1114156981
Provider Name (Legal Business Name): RAVICHANDRA JULURI D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DR. D. B. TODD JR. BLVD PERIODONTICS
NASHVILLE TN
37208-3599
US

IV. Provider business mailing address

705 HILLMEADE DR
NASHVILLE TN
37221-2262
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-6014
  • Fax: 615-327-6246
Mailing address:
  • Phone: 646-238-6196
  • Fax: 615-327-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8930
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401412308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: