Provider Demographics
NPI:1245541168
Name:RAGURAM, AMUTHA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMUTHA
Middle Name:
Last Name:RAGURAM
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 1:13 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5004
Mailing Address - Country:US
Mailing Address - Phone:650-576-8237
Mailing Address - Fax:
Practice Address - Street 1:50 RIVERDALE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3642
Practice Address - Country:US
Practice Address - Phone:914-375-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02427000122300000X
NY055266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist