Provider Demographics
NPI:1427454198
Name:DAVE, VRUTTI (DDS)
Entity type:Individual
Prefix:
First Name:VRUTTI
Middle Name:
Last Name:DAVE
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 1:800 COMMUNITY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3821
Mailing Address - Country:US
Mailing Address - Phone:516-869-9500
Mailing Address - Fax:
Practice Address - Street 1:800 COMMUNITY DR STE 200
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3821
Practice Address - Country:US
Practice Address - Phone:516-869-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021188122300000X
NY0577691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist