Provider Demographics
NPI:1386855450
Name:RAGUNANTHAN, KANTHASAMY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KANTHASAMY
Middle Name:K
Last Name:RAGUNANTHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KANTHASAMY
Other - Middle Name:
Other - Last Name:RAGUNANTHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:603 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-3121
Mailing Address - Country:US
Mailing Address - Phone:330-453-8787
Mailing Address - Fax:330-453-9292
Practice Address - Street 1:603 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-3121
Practice Address - Country:US
Practice Address - Phone:330-453-8787
Practice Address - Fax:330-453-9292
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist