Provider Demographics
NPI:1134321318
Name:RENGASAMY, KANDASAMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KANDASAMY
Middle Name:
Last Name:RENGASAMY
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 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:UCONN SCHOOL OF DENTAL MEDICINE
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2105
Mailing Address - Country:US
Mailing Address - Phone:860-679-2207
Mailing Address - Fax:860-679-1899
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:UCONN SCHOOL OF DENTAL MEDICINE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2105
Practice Address - Country:US
Practice Address - Phone:860-679-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0104351223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology