Provider Demographics
NPI:1659011104
Name:AJMERI, RICHA PANARA (DMD)
Entity type:Individual
Prefix:
First Name:RICHA
Middle Name:PANARA
Last Name:AJMERI
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 1:22-18 JACKSON AVE
Mailing Address - Street 2:UNIT 321
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101
Mailing Address - Country:US
Mailing Address - Phone:727-460-2199
Mailing Address - Fax:
Practice Address - Street 1:21 SPRING ST FRNT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4136
Practice Address - Country:US
Practice Address - Phone:212-226-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03002900122300000X
NY063331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist