Provider Demographics
NPI:1407979248
Name:CHERUKURI, VIJAYA RAO (DDS FICD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:RAO
Last Name:CHERUKURI
Suffix:
Gender:F
Credentials:DDS FICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 TENTH STREET
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-627-6699
Mailing Address - Fax:909-627-6975
Practice Address - Street 1:12850 TENTH STREET
Practice Address - Street 2:SUITE B-2
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-627-6699
Practice Address - Fax:909-627-6975
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA034314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist