Provider Demographics
NPI:1073002697
Name:RAM, KHUSHALI
Entity type:Individual
Prefix:
First Name:KHUSHALI
Middle Name:
Last Name:RAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LARK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2608
Mailing Address - Country:US
Mailing Address - Phone:732-910-3882
Mailing Address - Fax:
Practice Address - Street 1:2140 VOORHEES TOWN CTR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1911
Practice Address - Country:US
Practice Address - Phone:856-770-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0426241223P0221X
390200000X
NJ22DI028852001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program