Provider Demographics
NPI:1790867646
Name:KOKKIRALA, RAJESHWERRAO (DDS)
Entity Type:Individual
Prefix:
First Name:RAJESHWERRAO
Middle Name:
Last Name:KOKKIRALA
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 1:115 N HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1900
Mailing Address - Country:US
Mailing Address - Phone:718-681-8901
Mailing Address - Fax:718-681-8901
Practice Address - Street 1:1418 WYTHE PLACE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452
Practice Address - Country:US
Practice Address - Phone:718-681-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0372031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice