Provider Demographics
NPI:1245453000
Name:SUMITHRA, NAMASSIVAYA (BDS)
Entity type:Individual
Prefix:DR
First Name:NAMASSIVAYA
Middle Name:
Last Name:SUMITHRA
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 ROUTE 9
Mailing Address - Street 2:BUILDING 2,SUITE7
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6587
Mailing Address - Country:US
Mailing Address - Phone:518-371-2513
Mailing Address - Fax:518-371-4633
Practice Address - Street 1:1407 ROUTE 9
Practice Address - Street 2:BULDING 2,SUITE7
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-6587
Practice Address - Country:US
Practice Address - Phone:518-371-2513
Practice Address - Fax:518-371-2513
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0370141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice