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General NPI Number Information
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NPI Number | 1457840928
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Entity Type | Organization
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Legal Business Name | CHITRA TIRUVEEDULA,DDS A PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 26831 ALISO CREEK RD STE 202
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5341
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Country | US
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Telephone | 949-289-9993
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Fax |
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Provider Business Mailing Address
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Address Line | 26831 ALISO CREEK RD STE 202
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5341
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Country | US
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Telephone | 949-362-8523
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ADVANCED DENTAL
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Credential | DDS
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Telephone | 949-362-8523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 64482
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License Number State | CA
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