Provider Demographics
NPI:1881124212
Name:PARACHURU, VENKATA PRAVEEN BABU (BDS, MDS, PHD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:PRAVEEN BABU
Last Name:PARACHURU
Suffix:
Gender:M
Credentials:BDS, MDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6332 FRANKLIN GATE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8166
Mailing Address - Country:US
Mailing Address - Phone:612-772-6494
Mailing Address - Fax:
Practice Address - Street 1:137 RICK FRANCIS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2808
Practice Address - Country:US
Practice Address - Phone:915-215-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR689122300000X
TX367021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist