Provider Demographics
NPI:1538783543
Name:CHINNI, SUBRAMANYESWARASWAMY (DDS)
Entity type:Individual
Prefix:DR
First Name:SUBRAMANYESWARASWAMY
Middle Name:
Last Name:CHINNI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N GRIMES ST STE B8
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2131
Mailing Address - Country:US
Mailing Address - Phone:304-654-1384
Mailing Address - Fax:
Practice Address - Street 1:310 S ALLEN AVE
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4304
Practice Address - Country:US
Practice Address - Phone:432-943-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD52751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice