Provider Demographics
NPI:1770967093
Name:RAVICHANDRAN, DEEPA (DMD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:RAVICHANDRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:SELVAKUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 JOHN A CUMMINGS WAY
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3244
Mailing Address - Country:US
Mailing Address - Phone:617-750-2135
Mailing Address - Fax:
Practice Address - Street 1:25 JOHN A CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3244
Practice Address - Country:US
Practice Address - Phone:401-767-4161
Practice Address - Fax:401-767-5441
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN034771223G0001X
MADN18569591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice