Provider Demographics
NPI:1427407840
Name:KEDARSETTY, SANTOSHIRATNAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANTOSHIRATNAM
Middle Name:
Last Name:KEDARSETTY
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 1:7824 NORMANDIE BLVD APT K87
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6916
Mailing Address - Country:US
Mailing Address - Phone:937-546-8997
Mailing Address - Fax:440-654-2778
Practice Address - Street 1:42707 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1054
Practice Address - Country:US
Practice Address - Phone:440-324-3441
Practice Address - Fax:440-324-3488
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30247941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice