Provider Demographics
NPI:1306130240
Name:CHAPALA, HEMA KISHORE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEMA KISHORE
Middle Name:
Last Name:CHAPALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 CALCOT DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6610
Mailing Address - Country:US
Mailing Address - Phone:917-376-4408
Mailing Address - Fax:
Practice Address - Street 1:216 DALTON DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4414
Practice Address - Country:US
Practice Address - Phone:972-230-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX298418904Medicaid