Provider Demographics
NPI:1467948604
Name:DOKKU, CHANDRIKA SRUTHI
Entity Type:Individual
Prefix:
First Name:CHANDRIKA SRUTHI
Middle Name:
Last Name:DOKKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HIGH PARK LN APT 726
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4173
Mailing Address - Country:US
Mailing Address - Phone:301-658-4936
Mailing Address - Fax:
Practice Address - Street 1:2321 DULLES STATION BLVD STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6278
Practice Address - Country:US
Practice Address - Phone:703-424-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014167251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFD8986727OtherDEA