Provider Demographics
NPI:1588086227
Name:CHARUGUNDLA, BHARATHI (DMD)
Entity type:Individual
Prefix:DR
First Name:BHARATHI
Middle Name:
Last Name:CHARUGUNDLA
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 1:2138 NW THORNCROFT DR APT 814
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9019
Mailing Address - Country:US
Mailing Address - Phone:650-279-6250
Mailing Address - Fax:
Practice Address - Street 1:1320 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5833
Practice Address - Country:US
Practice Address - Phone:503-224-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist