Provider Demographics
NPI:1699011080
Name:SURESH, RAMYA KANNAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAMYA
Middle Name:KANNAN
Last Name:SURESH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RUKMANI
Other - Middle Name:
Other - Last Name:KANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:1317 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3452
Mailing Address - Country:US
Mailing Address - Phone:978-944-0589
Mailing Address - Fax:
Practice Address - Street 1:129 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2402
Practice Address - Country:US
Practice Address - Phone:508-754-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18561661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice