Provider Demographics
NPI:1194878272
Name:RAMAKRISHNAN, PRADEEP (DDS)
Entity type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:RAMAKRISHNAN
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 1:61 CLINTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2452
Mailing Address - Country:US
Mailing Address - Phone:201-374-1234
Mailing Address - Fax:201-374-1234
Practice Address - Street 1:1 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5324
Practice Address - Country:US
Practice Address - Phone:718-237-0222
Practice Address - Fax:718-522-1556
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist