Provider Demographics
NPI:1538253596
Name:VERA, CHENGETO MUKONOWESHURO (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:CHENGETO
Middle Name:MUKONOWESHURO
Last Name:VERA
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:DR
Other - First Name:CHENGETO
Other - Middle Name:
Other - Last Name:MUKONOWESHURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MPH
Mailing Address - Street 1:144 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3208
Mailing Address - Country:US
Mailing Address - Phone:508-754-9825
Mailing Address - Fax:508-754-9898
Practice Address - Street 1:144 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3208
Practice Address - Country:US
Practice Address - Phone:508-754-9825
Practice Address - Fax:508-754-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry