Healthcare Provider Details

I. General information

NPI: 1750296794
Provider Name (Legal Business Name): CHENNA VENKATA NAGA SAI SAT CHAKKA BDS, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E KARSCH BLVD
FARMINGTON MO
63640-3025
US

IV. Provider business mailing address

807 E KARSCH BLVD
FARMINGTON MO
63640-3025
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-5760
  • Fax:
Mailing address:
  • Phone: 573-637-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026034671
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: