Provider Demographics
NPI:1447709720
Name:RAJU, KAMPA (DMD)
Entity type:Individual
Prefix:
First Name:KAMPA
Middle Name:
Last Name:RAJU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 GERBERA DR
Mailing Address - Street 2:APT 11107
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-9025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8125 GERBERA DR
Practice Address - Street 2:APT 11107
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-9025
Practice Address - Country:US
Practice Address - Phone:352-214-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist