Provider Demographics
NPI:1699251207
Name:RAJECH CHUNDURI DMD PC
Entity type:Organization
Organization Name:RAJECH CHUNDURI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNDURI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-715-4080
Mailing Address - Street 1:1620 W EL CAMINO AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3631
Mailing Address - Country:US
Mailing Address - Phone:916-993-9207
Mailing Address - Fax:916-550-1361
Practice Address - Street 1:1620 W EL CAMINO AVE STE 170
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3631
Practice Address - Country:US
Practice Address - Phone:916-993-9207
Practice Address - Fax:916-550-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty