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General NPI Number Information
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NPI Number | 1194213314
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Entity Type | Individual
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Provider Name | SURYA CHAKRAVARTHY PAMULAPATI BDS, MPH
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Gender | Male
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 6016 GLENWAY AVE
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City | CINCINNATI
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State | OH
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Zip | 45211-6318
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Country | US
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Telephone | 513-697-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 6476 TYLERSVILLE RD
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City | WEST CHESTER
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State | OH
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Zip | 45069-5412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.026329
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License Number State | OH
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