Basic Information
| Provider Information | |||||||||
| NPI: | 1528258605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAJU | ||||||||
| FirstName: | CHIKKA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1841 | ||||||||
| Address2: | |||||||||
| City: | NORCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928600991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517372683 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1028 E WALNUT CREEK PKWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917903072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269191393 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 36823 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.