Provider Demographics
NPI:1386909992
Name:CHELLUR, PALLAVI (DMD)
Entity type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:CHELLUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 RTE 27
Mailing Address - Street 2:STE B
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5010
Mailing Address - Country:US
Mailing Address - Phone:678-401-5922
Mailing Address - Fax:
Practice Address - Street 1:2864 ROUTE 27 STE B
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5010
Practice Address - Country:US
Practice Address - Phone:732-297-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856032122300000X
NJ22DI02533400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist