Provider Demographics
NPI:1912069295
Name:SAMPATHKUMAR, VENKATESH (DDS, MA)
Entity Type:Individual
Prefix:DR
First Name:VENKATESH
Middle Name:
Last Name:SAMPATHKUMAR
Suffix:
Gender:M
Credentials:DDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 THE CIR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2725
Mailing Address - Country:US
Mailing Address - Phone:631-324-6800
Mailing Address - Fax:631-324-7744
Practice Address - Street 1:56 THE CIR
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2725
Practice Address - Country:US
Practice Address - Phone:631-324-6800
Practice Address - Fax:631-324-7744
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist