Provider Demographics
NPI:1003522756
Name:SUMANYA VENKAT RAO DDS PC
Entity Type:Organization
Organization Name:SUMANYA VENKAT RAO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUMANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKAT RAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-781-7188
Mailing Address - Street 1:2030 LIBERTY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6129
Mailing Address - Country:US
Mailing Address - Phone:410-781-7188
Mailing Address - Fax:443-609-4713
Practice Address - Street 1:2030 LIBERTY RD STE 1
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6129
Practice Address - Country:US
Practice Address - Phone:410-781-7188
Practice Address - Fax:443-609-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental