Provider Demographics
NPI:1245716661
Name:VENKAT, SHANKAR (BDS)
Entity type:Individual
Prefix:
First Name:SHANKAR
Middle Name:
Last Name:VENKAT
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:DR
Other - First Name:SHANKAR
Other - Middle Name:
Other - Last Name:VENKAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS
Mailing Address - Street 1:315 NC HIGHWAY 55 W
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-8527
Mailing Address - Country:US
Mailing Address - Phone:919-658-9555
Mailing Address - Fax:
Practice Address - Street 1:315 NC HIGHWAY 55 W
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-8527
Practice Address - Country:US
Practice Address - Phone:919-658-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02701223P0106X
NC144381223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology