Provider Demographics
NPI:1174741953
Name:VENKATADRI, CHALASANI (DMD)
Entity type:Individual
Prefix:DR
First Name:CHALASANI
Middle Name:
Last Name:VENKATADRI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MARIETTA ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2883
Mailing Address - Country:US
Mailing Address - Phone:404-577-0868
Mailing Address - Fax:
Practice Address - Street 1:75 MARIETTA ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2883
Practice Address - Country:US
Practice Address - Phone:404-577-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0129931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8356724778Medicaid