Provider Demographics
NPI:1104434752
Name:KULATHANAL CHAKRAPANI, PAVANA
Entity type:Individual
Prefix:DR
First Name:PAVANA
Middle Name:
Last Name:KULATHANAL CHAKRAPANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 KENDALL HILL CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4519
Mailing Address - Country:US
Mailing Address - Phone:832-870-3858
Mailing Address - Fax:
Practice Address - Street 1:1072 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4804
Practice Address - Country:US
Practice Address - Phone:281-661-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice