Provider Demographics
NPI:1508267626
Name:VAITHILINGHAM, SINTHUJAH (DMD)
Entity Type:Individual
Prefix:
First Name:SINTHUJAH
Middle Name:
Last Name:VAITHILINGHAM
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 1:585 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5314
Mailing Address - Country:US
Mailing Address - Phone:718-624-6204
Mailing Address - Fax:
Practice Address - Street 1:585 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5314
Practice Address - Country:US
Practice Address - Phone:718-624-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0579491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice