Provider Demographics
NPI:1225209570
Name:CHALLA, SUMAN (BDS, MSPH)
Entity type:Individual
Prefix:
First Name:SUMAN
Middle Name:
Last Name:CHALLA
Suffix:
Gender:M
Credentials:BDS, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC 7917
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-3188
Mailing Address - Fax:210-567-4587
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:MC 7917
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-3188
Practice Address - Fax:210-567-4587
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-226041223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health