Healthcare Provider Details

I. General information

NPI: 1356871883
Provider Name (Legal Business Name): NAGA SUCHARITHA TADEPALLI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 EDWIN DR STE 200
CHESAPEAKE VA
23322-6531
US

IV. Provider business mailing address

1933 EDWIN DR STE 200
CHESAPEAKE VA
23322-6531
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-2134
  • Fax:
Mailing address:
  • Phone: 757-547-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401415709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: