Provider Demographics
NPI:1700942505
Name:RAO, VASANTHA (DMD DENTIST)
Entity Type:Individual
Prefix:MRS
First Name:VASANTHA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:DMD DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DURSELY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-222-9271
Mailing Address - Fax:
Practice Address - Street 1:6260 HWY 76
Practice Address - Street 2:SHOBHA DENTAL CARE CENTER
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670
Practice Address - Country:US
Practice Address - Phone:864-332-0530
Practice Address - Fax:864-332-1201
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3738Medicaid