Provider Demographics
NPI:1841344926
Name:PREMARAJ, SUNDARALINGAM (BDS, MS, PHD)
Entity type:Individual
Prefix:MR
First Name:SUNDARALINGAM
Middle Name:
Last Name:PREMARAJ
Suffix:
Gender:M
Credentials:BDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SOUTH UNIVERSITY DRIVE
Mailing Address - Street 2:NOVA SOUTHWESTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-262-1896
Mailing Address - Fax:
Practice Address - Street 1:3200 SOUTH UNIVERSITY DRIVE
Practice Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-262-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1121223X0400X
FLDTP7591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4562OtherBC/BS
FLDTP759OtherFLORIDA DENTAL TEACHING PERMIT