Provider Demographics
NPI:1346303328
Name:RAMESH, LAKSHMI (DDS)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:RAMESH
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 1:2103 E WASHINGTON ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4362
Mailing Address - Country:US
Mailing Address - Phone:309-664-7645
Mailing Address - Fax:309-664-7647
Practice Address - Street 1:2103 E WASHINGTON ST STE 4B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4362
Practice Address - Country:US
Practice Address - Phone:309-664-7645
Practice Address - Fax:309-664-7647
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist