Provider Demographics
NPI:1174836134
Name:VIKRAM, TULASI N (DDS)
Entity Type:Individual
Prefix:DR
First Name:TULASI
Middle Name:N
Last Name:VIKRAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TULASI
Other - Middle Name:N
Other - Last Name:VIKRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BDS, DDS
Mailing Address - Street 1:40 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-6140
Mailing Address - Country:US
Mailing Address - Phone:603-943-4271
Mailing Address - Fax:
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-574-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice