Provider Demographics
NPI:1588045694
Name:DURGAM, ESTHER SIRISHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:SIRISHA
Last Name:DURGAM
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 1:669 10TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4502
Mailing Address - Country:US
Mailing Address - Phone:240-643-4927
Mailing Address - Fax:
Practice Address - Street 1:669 10TH ST APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4509
Practice Address - Country:US
Practice Address - Phone:240-643-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist