Provider Demographics
NPI:1710186374
Name:SUNDARESAN, DAMAYANTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMAYANTHY
Middle Name:
Last Name:SUNDARESAN
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 1:77 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1513
Mailing Address - Country:US
Mailing Address - Phone:732-926-1234
Mailing Address - Fax:732-926-8877
Practice Address - Street 1:77 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1513
Practice Address - Country:US
Practice Address - Phone:732-926-1234
Practice Address - Fax:732-926-8877
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0196400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist