Provider Demographics
NPI:1295119444
Name:VIJAYA R CHERUKURI DDS INC
Entity type:Organization
Organization Name:VIJAYA R CHERUKURI DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-627-6699
Mailing Address - Street 1:12850 10TH ST STE B2
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4295
Mailing Address - Country:US
Mailing Address - Phone:909-627-6699
Mailing Address - Fax:909-627-6975
Practice Address - Street 1:12850 10TH ST STE B2
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4295
Practice Address - Country:US
Practice Address - Phone:909-627-6699
Practice Address - Fax:909-627-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA034314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty