Provider Demographics
NPI:1972799963
Name:RAJAGOPALAN, SUJITHRA (DDS)
Entity type:Individual
Prefix:DR
First Name:SUJITHRA
Middle Name:
Last Name:RAJAGOPALAN
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 1:330 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3469
Mailing Address - Country:US
Mailing Address - Phone:732-846-8383
Mailing Address - Fax:732-846-8395
Practice Address - Street 1:330 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3469
Practice Address - Country:US
Practice Address - Phone:732-846-8383
Practice Address - Fax:732-846-8395
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023572001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice