Provider Demographics
NPI:1669736088
Name:SUBRAMANI, RATHIDEVI
Entity type:Individual
Prefix:DR
First Name:RATHIDEVI
Middle Name:
Last Name:SUBRAMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:RATHIDEVI
Other - Middle Name:
Other - Last Name:SUBRAMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:866 OAK RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-9219
Mailing Address - Country:US
Mailing Address - Phone:847-739-6272
Mailing Address - Fax:
Practice Address - Street 1:853 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1992
Practice Address - Country:US
Practice Address - Phone:630-879-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist