Provider Demographics
NPI:1558739599
Name:SUBGANI, RAMYA (DDS)
Entity Type:Individual
Prefix:
First Name:RAMYA
Middle Name:
Last Name:SUBGANI
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 1:707 1/2 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4853
Mailing Address - Country:US
Mailing Address - Phone:716-367-9575
Mailing Address - Fax:
Practice Address - Street 1:707 1/2 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4853
Practice Address - Country:US
Practice Address - Phone:716-367-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD44051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice