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General NPI Number Information
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NPI Number | 1740593342
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Entity Type | Individual
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Provider Name | MANEESHA R CHIGURUPATI DDS
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Gender | Female
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 117 KERNEYWOOD ST
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City | LAKELAND
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State | FL
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Zip | 33803-2945
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Country | US
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Telephone | 804-239-5824
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Fax |
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Provider Business Mailing Address
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Address Line | 117 KERNEYWOOD ST
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City | LAKELAND
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State | FL
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Zip | 33803-2945
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Country | US
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Telephone | 863-687-2759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN25638
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License Number State | FL
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