Provider Demographics
NPI:1053888057
Name:CHINTALA, ANUSHA (DMD)
Entity type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:CHINTALA
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 1:2302 HENDRICKSON DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6185
Mailing Address - Country:US
Mailing Address - Phone:715-836-0136
Mailing Address - Fax:
Practice Address - Street 1:2302 HENDRICKSON DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6185
Practice Address - Country:US
Practice Address - Phone:715-836-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001959-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist