Active NPI
Prakruthi Cegu Phani Raj, DDS
- General Practice Dentistry
- Smyrna, TN
National Provider Identifier
1851065296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11676
- Practice address
- 440 W Sam Ridley Pkwy Ste 140
Smyrna, TN 37167-2999 - Phone
- (615) 768-3242
- NPI assigned
- Aug 8, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11676 | TN | Primary |
Addresses
Primary practice location
440 W Sam Ridley Pkwy Ste 140
Smyrna, TN 37167-2999
Mailing address
9199 Tryon CV
Cordova, TN 38018-2946
Phone (901) 857-5640
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 |
|---|---|---|---|
| 11676 | TN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628380800000",
"number": "1851065296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9199 TRYON CV",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380182946",
"telephone_number": "901-857-5640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 W SAM RIDLEY PKWY STE 140",
"city": "SMYRNA",
"state": "TN",
"postal_code": "371672999",
"telephone_number": "615-768-3242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CEGU PHANI RAJ",
"first_name": "PRAKRUTHI",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-08",
"last_updated": "2021-08-08",
"certification_date": "2021-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "11676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, TN
- Jacqueline Castro Aguilar
- Jillian Marie Catchings, RN, IBCLC
- Cecily M Williams DDS, PC
- Cedar Grove Medical Associates,LLC
- Cedar Medical Group, PC
- Center for Marriage & Family Health
- Center for Neurological Treatment & Research, PLLC
- Centerwell Senior Primary Care TN PC
- Cassandra Cervantes, PA
- Camille Chamberlen, CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.