Provider Demographics
NPI:1376063990
Name:PARUCHURI, ROSHINI DURGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSHINI DURGA
Middle Name:
Last Name:PARUCHURI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2138
Mailing Address - Country:US
Mailing Address - Phone:765-742-1567
Mailing Address - Fax:765-429-2700
Practice Address - Street 1:1324 TIPPECANOE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2051
Practice Address - Country:US
Practice Address - Phone:765-742-1567
Practice Address - Fax:765-429-2794
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013119A1223G0001X
IL019031231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist