Provider Demographics
NPI:1801047485
Name:BHAGAVAN, RAMYA (DMD)
Entity type:Individual
Prefix:DR
First Name:RAMYA
Middle Name:
Last Name:BHAGAVAN
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 1:11147 YELLOW LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:GERMAN TOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876
Mailing Address - Country:US
Mailing Address - Phone:301-528-0176
Mailing Address - Fax:
Practice Address - Street 1:3733 JEFFERSON PIKE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:MD
Practice Address - Zip Code:21755-8124
Practice Address - Country:US
Practice Address - Phone:301-834-8804
Practice Address - Fax:301-371-0232
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist