Provider Demographics
NPI:1841394970
Name:DAMARAJU, VENKATRAYUDU (DMD)
Entity Type:Individual
Prefix:DR
First Name:VENKATRAYUDU
Middle Name:
Last Name:DAMARAJU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:1198 MT. BETHAL HWY
Mailing Address - City:MT. BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:18343
Mailing Address - Country:US
Mailing Address - Phone:610-588-5000
Mailing Address - Fax:610-588-5004
Practice Address - Street 1:1198 MT. BETHEL HWY
Practice Address - Street 2:
Practice Address - City:MT. BETHEL
Practice Address - State:PA
Practice Address - Zip Code:18343
Practice Address - Country:US
Practice Address - Phone:610-588-5000
Practice Address - Fax:610-588-5004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029257L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice