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General NPI Number Information
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NPI Number | 1780336396
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Entity Type | Organization
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Legal Business Name | MANEESHA CHIGURUPATI DDS, PLLC
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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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 | 863-687-2759
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Fax |
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Provider Business Mailing Address
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Address Line | 819 JOHN CRESSLER DR
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City | SEFFNER
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State | FL
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Zip | 33584-3919
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Country | US
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Telephone | 804-239-5824
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MANEESHA CHIGURUPATI
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Credential | DDS
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Telephone | 804-239-5824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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