Provider Demographics
NPI:1497217848
Name:RAM, MEERA LAKSHMI (DMD)
Entity Type:Individual
Prefix:
First Name:MEERA
Middle Name:LAKSHMI
Last Name:RAM
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 1:1 NASSAU ST UNIT 1605
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1584
Mailing Address - Country:US
Mailing Address - Phone:352-601-0196
Mailing Address - Fax:
Practice Address - Street 1:95 LYNN ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5705
Practice Address - Country:US
Practice Address - Phone:978-532-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18586261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program