Provider Demographics
NPI:1073581856
Name:RAO, CHERUKUPALLI SRINIVAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERUKUPALLI
Middle Name:SRINIVAS
Last Name:RAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 EAST AVE STE R
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1052
Mailing Address - Country:US
Mailing Address - Phone:530-345-4780
Mailing Address - Fax:530-345-4781
Practice Address - Street 1:1074 EAST AVE STE R
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1052
Practice Address - Country:US
Practice Address - Phone:530-345-4780
Practice Address - Fax:530-345-4781
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist