MEDICARE: DR. CHERUKUPALLI SRINIVAS RAO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	49492	CA

General Provider Information

NPI Number	:	1073581856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERUKUPALLI SRINIVAS RAO DDS

Provider Business Mailing Address
First Line	:	1074 EAST AVE STE R
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-1052
Country	:	US
Telephone Number	:	530-345-4780
Fax Number	:	530-345-4781

Provider Business Practice Location Address
First Line	:	1074 EAST AVE STE R
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-1052
Country	:	US
Telephone Number	:	530-345-4780
Fax Number	:	530-345-4781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	09/17/2018

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