Provider Demographics
NPI:1407903404
Name:LAXMINARAYAN, REVATHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:REVATHI
Middle Name:
Last Name:LAXMINARAYAN
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 1:45 LUDLOW ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1947
Mailing Address - Country:US
Mailing Address - Phone:914-423-2493
Mailing Address - Fax:914-423-0263
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:SUITE 606
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-423-2493
Practice Address - Fax:914-423-0263
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0448231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice