Provider Demographics
NPI:1235519208
Name:ADUSUMILLI, VENKATA RAMA KRISHNA RAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:RAMA KRISHNA RAO
Last Name:ADUSUMILLI
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 1:45 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1238
Mailing Address - Country:US
Mailing Address - Phone:814-642-7232
Mailing Address - Fax:
Practice Address - Street 1:45 N PINE ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1238
Practice Address - Country:US
Practice Address - Phone:814-642-7232
Practice Address - Fax:814-642-7322
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30930122300000X
PADS040693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA040693OtherPA STATE DENTAL LICENSE