Provider Demographics
NPI:1568813509
Name:SUBRAMANIAN, VIPUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23140 MOAKLEY ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2931
Mailing Address - Country:US
Mailing Address - Phone:301-475-2881
Mailing Address - Fax:
Practice Address - Street 1:23140 MOAKLEY ST STE 5
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2931
Practice Address - Country:US
Practice Address - Phone:301-475-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist