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General NPI Number Information
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NPI Number | 1699251207
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Entity Type | Organization
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Legal Business Name | RAJECH CHUNDURI DMD PC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 1620 W EL CAMINO AVE STE 170
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City | SACRAMENTO
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State | CA
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Zip | 95833-3631
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Country | US
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Telephone | 916-993-9207
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Fax | 916-550-1361
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Provider Business Mailing Address
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Address Line | 1620 W EL CAMINO AVE STE 170
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City | SACRAMENTO
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State | CA
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Zip | 95833-3631
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Country | US
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Telephone | 916-993-9207
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Fax | 916-550-1361
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Authorized Official
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Title or Position | DOCTOR
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Name | RAJESH CHUNDURI
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Credential | DMD
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Telephone | 916-715-4080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61569
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License Number State | CA
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