Provider Demographics
NPI:1679687826
Name:SAMPAT, RAMESH D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:D
Last Name:SAMPAT
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 1:323 E CASS ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2814
Mailing Address - Country:US
Mailing Address - Phone:815-722-1444
Mailing Address - Fax:815-722-1472
Practice Address - Street 1:323 E CASS ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2814
Practice Address - Country:US
Practice Address - Phone:815-722-1444
Practice Address - Fax:815-722-1472
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice