Provider Demographics
NPI:1225411770
Name:SUNDARAM, PADMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PADMA
Middle Name:
Last Name:SUNDARAM
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 1:57 BAY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2510
Mailing Address - Country:US
Mailing Address - Phone:844-400-1975
Mailing Address - Fax:845-765-9324
Practice Address - Street 1:57 BAY ST FL 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2510
Practice Address - Country:US
Practice Address - Phone:844-400-1975
Practice Address - Fax:845-765-9324
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist