Provider Demographics
NPI:1851132690
Name:RAVINDRAN, HARITA KAMALAM (DMD)
Entity type:Individual
Prefix:
First Name:HARITA KAMALAM
Middle Name:
Last Name:RAVINDRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ANGELO CIFELLI DR APT 270
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2909
Mailing Address - Country:US
Mailing Address - Phone:631-568-6116
Mailing Address - Fax:
Practice Address - Street 1:1907 OAK TREE RD STE 204
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2070
Practice Address - Country:US
Practice Address - Phone:908-316-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030316001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice