Provider Demographics
NPI:1578732582
Name:RAVEENDRANATH, SWAPNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SWAPNA
Middle Name:
Last Name:RAVEENDRANATH
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 1:39055 HASTINGS ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1518
Mailing Address - Country:US
Mailing Address - Phone:510-791-3144
Mailing Address - Fax:510-791-3140
Practice Address - Street 1:39055 HASTINGS ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1518
Practice Address - Country:US
Practice Address - Phone:510-791-3144
Practice Address - Fax:510-791-3140
Is Sole Proprietor?:No
Enumeration Date:2008-02-23
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist