Provider Demographics
NPI:1215240452
Name:CHERUKURI, VENKATA NAVEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:NAVEEN
Last Name:CHERUKURI
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 1:4310 PHYSICIANS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7404
Mailing Address - Country:US
Mailing Address - Phone:980-258-0866
Mailing Address - Fax:
Practice Address - Street 1:4310 PHYSICIANS BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7404
Practice Address - Country:US
Practice Address - Phone:980-258-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103681223G0001X
WADE601644841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice