Provider Demographics
NPI:1104318278
Name:DANDU, SHRUTI RAJU (DDS)
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:RAJU
Last Name:DANDU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 NANEL DR APT D
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2263
Mailing Address - Country:US
Mailing Address - Phone:512-955-2972
Mailing Address - Fax:
Practice Address - Street 1:96 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1944
Practice Address - Country:US
Practice Address - Phone:512-955-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist