Provider Demographics
NPI:1255819470
Name:SUMANYA VENKAT RAO DDS PC
Entity type:Organization
Organization Name:SUMANYA VENKAT RAO DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKAT RAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-898-6788
Mailing Address - Street 1:3635 OLD COURT RD STE 510
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3916
Mailing Address - Country:US
Mailing Address - Phone:443-898-6788
Mailing Address - Fax:443-213-5620
Practice Address - Street 1:3635 OLD COURT RD STE 510
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3916
Practice Address - Country:US
Practice Address - Phone:443-540-6007
Practice Address - Fax:443-609-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15681261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD089290400Medicaid