Provider Demographics
NPI:1891009593
Name:RAMYA JAGANNATHAN, NOT GIVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOT GIVEN
Middle Name:
Last Name:RAMYA JAGANNATHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 STUMPH RD
Mailing Address - Street 2:APT#205
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1714
Mailing Address - Country:US
Mailing Address - Phone:216-258-4285
Mailing Address - Fax:
Practice Address - Street 1:3329 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3315
Practice Address - Country:US
Practice Address - Phone:216-398-8900
Practice Address - Fax:216-741-3131
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0232961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice