Prakruthi Cegu Phani Raj, DDS
Dentist, General Practice in Smyrna, TN. Individual provider (NPI-1).
NPI number1851065296
StatusActive
Last updated in NPPESAug 8, 2021
Details
- NPI
- 1851065296
- Entity type
- Individual (NPI-1)
- Name
- Prakruthi Cegu Phani Raj
- Credential
- DDS
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 8, 2021
- Certification date
- Aug 8, 2021
- Last updated
- Aug 8, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 11676 | TN | Yes |
Practice location
440 W Sam Ridley Pkwy Ste 140Smyrna, TN 37167-2999
Phone 615-768-3242
Mailing address
9199 Tryon CvCordova, TN 38018-2946
Phone 901-857-5640
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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