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Individual

GIRIDHARA K CHITTIVELU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
526 S TONOPAH DR, STE. 200, LAS VEGAS, NV 89106-4043
(702) 291-2031
(702) 366-1483
Mailing address
526 S TONOPAH DR, STE. 200, LAS VEGAS, NV 89106-4043
(702) 291-2031
(702) 366-1483

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
21385
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
S3-264
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0205290
MA
05
1902977168
NV
Enumeration date
11/10/2006
Last updated
06/15/2016
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