Provider Demographics
NPI:1114379179
Name:ANNAM, KUMARRAGHAVACHOWDARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KUMARRAGHAVACHOWDARY
Middle Name:
Last Name:ANNAM
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 1:161 JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5892
Mailing Address - Country:US
Mailing Address - Phone:740-692-7100
Mailing Address - Fax:
Practice Address - Street 1:161 JAMES WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5892
Practice Address - Country:US
Practice Address - Phone:740-692-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist