Provider Demographics
NPI:1881022333
Name:SIVA S. CHERUKURI DDS INC
Entity Type:Organization
Organization Name:SIVA S. CHERUKURI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPIRNENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-829-9674
Mailing Address - Street 1:2930 ABORN SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1504
Mailing Address - Country:US
Mailing Address - Phone:408-365-7446
Mailing Address - Fax:408-274-9990
Practice Address - Street 1:2930 ABORN SQUARE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1504
Practice Address - Country:US
Practice Address - Phone:408-365-7446
Practice Address - Fax:408-274-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty