Provider Demographics
NPI:1609216696
Name:SURYADEVARA, RAMAKUMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAMAKUMAR
Middle Name:
Last Name:SURYADEVARA
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 1:501 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2813
Mailing Address - Country:US
Mailing Address - Phone:315-452-1020
Mailing Address - Fax:315-410-1069
Practice Address - Street 1:501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2813
Practice Address - Country:US
Practice Address - Phone:315-452-1020
Practice Address - Fax:315-410-1696
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice