Active NPI
Pratheek Choudary Koneru, DDS
- Dentist
- Charlotte, NC
National Provider Identifier
1013576735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11436
- Practice address
- 8505 Davis Lake Pkwy
Charlotte, NC 28269-3415 - Phone
- (980) 430-6822
- NPI assigned
- Jun 6, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11436 | NC | Primary |
Addresses
Primary practice location
8505 Davis Lake Pkwy
Charlotte, NC 28269-3415
Mailing address
7312 Hagen CT Apt 1616
Charlotte, NC 28262-4044
Phone (630) 881-4745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11436 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559779200000",
"number": "1013576735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7312 HAGEN CT APT 1616",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282624044",
"telephone_number": "630-881-4745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8505 DAVIS LAKE PKWY",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282693415",
"telephone_number": "980-430-6822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONERU",
"first_name": "PRATHEEK",
"middle_name": "CHOUDARY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-06",
"last_updated": "2019-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "11436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.