Provider Demographics
NPI:1003170465
Name:SAKHAMURI, SARANYA (DMD)
Entity Type:Individual
Prefix:
First Name:SARANYA
Middle Name:
Last Name:SAKHAMURI
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 1:401 ENGAMORE LN APT 107
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2556
Mailing Address - Country:US
Mailing Address - Phone:732-614-1988
Mailing Address - Fax:
Practice Address - Street 1:135 BANK ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2205
Practice Address - Country:US
Practice Address - Phone:203-393-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-30
Last Update Date:2012-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010791122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist