Manvitha Kuchukulla, MDS

Primary specialty

Orofacial Pain DentistryTaxonomy code 1223X2210X

License

016.0133997 Issued in VT

Practice address

5352 Twin Hickory Rd
Glen Allen, VA 23059-5682

Phone

(804) 335-0599

NPI assigned

Jan 27, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1760073449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5352 TWIN HICKORY RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595682",
            "telephone_number": "804-335-0599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5352 TWIN HICKORY RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595682",
            "telephone_number": "804-335-0599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUCHUKULLA",
        "first_name": "MANVITHA",
        "name_prefix": "Dr.",
        "credential": "MDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-27",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "VT",
            "license": "016.0133997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orofacial Pain Dentistry in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Orofacial Pain Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; 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.