Provider Demographics
NPI:1447820071
Name:KAVURI, TEJA SRINIVAS SRINIVAS
Entity type:Individual
Prefix:DR
First Name:TEJA SRINIVAS
Middle Name:SRINIVAS
Last Name:KAVURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 UNDERWOOD ARBOR PL APT 8-7206
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7127
Mailing Address - Country:US
Mailing Address - Phone:312-206-8172
Mailing Address - Fax:
Practice Address - Street 1:6480 TRYON RD STE A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7050
Practice Address - Country:US
Practice Address - Phone:919-277-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice