Sucheta Raghavendra, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS042824 Issued in PA

Practice address

767 5TH Ave Ste B3-a
Chambersburg, PA 17201-4207

Phone

(717) 709-7940

NPI assigned

Aug 11, 2015

Last updated

Sep 16, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1649646837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 DREW AVE SE",
            "address_2": "SUITE 202",
            "city": "MADELIA",
            "state": "MN",
            "postal_code": "560621873",
            "telephone_number": "507-642-8742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "767 5TH AVE STE B3-A",
            "city": "CHAMBERSBURG",
            "state": "PA",
            "postal_code": "172014207",
            "telephone_number": "717-709-7940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Drew Ave SE",
            "address_2": "Suite 202",
            "address_purpose": "LOCATION",
            "city": "Madelia",
            "state": "MN",
            "postal_code": "560621873",
            "country_code": "US",
            "telephone_number": "507-642-8742",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6155 Anthony Hwy",
            "address_purpose": "LOCATION",
            "city": "Waynesboro",
            "state": "PA",
            "postal_code": "172689718",
            "country_code": "US",
            "telephone_number": "717-765-8664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAGHAVENDRA",
        "first_name": "SUCHETA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "13745",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.030443",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS042824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Chambersburg, PA
• Providers in Chambersburg, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.