Provider Demographics
NPI:1154335057
Name:RANGRASS, SAMBHAVITA (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMBHAVITA
Middle Name:
Last Name:RANGRASS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 E G AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1703
Mailing Address - Country:US
Mailing Address - Phone:269-382-5327
Mailing Address - Fax:269-382-2129
Practice Address - Street 1:1719 E G AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49004-1703
Practice Address - Country:US
Practice Address - Phone:269-382-5327
Practice Address - Fax:269-382-2129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice