Provider Demographics
NPI:1740593342
Name:CHIGURUPATI, MANEESHA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANEESHA
Middle Name:R
Last Name:CHIGURUPATI
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 1:117 KERNEYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2945
Mailing Address - Country:US
Mailing Address - Phone:863-687-2759
Mailing Address - Fax:
Practice Address - Street 1:117 KERNEYWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2945
Practice Address - Country:US
Practice Address - Phone:804-239-5824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist