MEDICARE: DR. PAVANA KULATHANAL CHAKRAPANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	36330	TX

General Provider Information

NPI Number	:	1104434752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAVANA KULATHANAL CHAKRAPANI

Provider Business Mailing Address
First Line	:	4114 KENDALL HILL CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4519
Country	:	US
Telephone Number	:	832-870-3858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1072 FEDERAL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-4804
Country	:	US
Telephone Number	:	281-661-6090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/23/2020

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