Provider Demographics
NPI:1700114097
Name:PONRAJ, ERNEST DEVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:DEVAN
Last Name:PONRAJ
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 1:4 TAFT CT STE 150
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5582
Mailing Address - Country:US
Mailing Address - Phone:301-598-7800
Mailing Address - Fax:301-963-6300
Practice Address - Street 1:4 TAFT CT STE 150
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5582
Practice Address - Country:US
Practice Address - Phone:301-598-7800
Practice Address - Fax:301-963-6300
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412323122300000X
DCDEN1001069122300000X
MD14719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist