Provider Demographics
NPI:1821184169
Name:GUNTNUR, RAJESWARI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJESWARI
Middle Name:
Last Name:GUNTNUR
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 1:3635 SABLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6264
Mailing Address - Country:US
Mailing Address - Phone:972-862-2045
Mailing Address - Fax:
Practice Address - Street 1:5409 N JIM MILLER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1542
Practice Address - Country:US
Practice Address - Phone:214-381-1272
Practice Address - Fax:214-381-6131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201872768OtherTAX ID#