Provider Demographics
NPI:1063775773
Name:PERSHAD, SAILESH RAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SAILESH
Middle Name:RAM
Last Name:PERSHAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 CLARE ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K1Z7E3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 FORD ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1402
Practice Address - Country:US
Practice Address - Phone:315-713-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2025-01-06
Deactivation Date:2017-08-30
Deactivation Code:
Reactivation Date:2025-01-06
Provider Licenses
StateLicense IDTaxonomies
NY0567481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice