Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 27371 | TX |
NPI | 1083986533 |
---|---|
Provider Name | Ramakiran Venkata Chavali |
First Address | Birmingham, AL 35294-0001 |
Second Address | Birmingham, AL 35243-3250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2012 |
Last Update Date | 07/01/2013 |