Individual
DR. REVANTH CHADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11212 PROFESSIONAL PARK DR, LOUISVILLE, KY 40291-4476
(612) 735-8159
Mailing address
11212 PROFESSIONAL PARK DR, LOUISVILLE, KY 40291-4476
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10740
KY
122300000X
Dentist
D13666
MN
1223E0200X
Endodontics
Primary
10740
KY
Other
Enumeration date
05/17/2016
Last updated
10/03/2023
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