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General NPI Number Information
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NPI Number | 1841394970
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Entity Type | Individual
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Provider Name | VENKATRAYUDU DAMARAJU D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 1198 MT. BETHEL HWY
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City | MT. BETHEL
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State | PA
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Zip | 18343
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Country | US
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Telephone | 610-588-5000
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Fax | 610-588-5004
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Provider Business Mailing Address
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Address Line | PO BOX 50 1198 MT. BETHAL HWY
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City | MT. BETHEL
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State | PA
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Zip | 18343
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Country | US
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Telephone | 610-588-5000
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Fax | 610-588-5004
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS029257L
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License Number State | PA
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