Provider Demographics
NPI:1881122539
Name:RAMANLAL, SHRESHTHA (DMD)
Entity type:Individual
Prefix:DR
First Name:SHRESHTHA
Middle Name:
Last Name:RAMANLAL
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 1:2810 JACKSON AVE APT 12M
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3130
Mailing Address - Country:US
Mailing Address - Phone:508-577-6463
Mailing Address - Fax:
Practice Address - Street 1:593 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2349
Practice Address - Country:US
Practice Address - Phone:516-561-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-08-30
Deactivation Date:2022-08-07
Deactivation Code:
Reactivation Date:2022-08-30
Provider Licenses
StateLicense IDTaxonomies
NY060523122300000X
MADN18575771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice