Provider Demographics
NPI:1952751687
Name:KEWALRAMANI, VANDANA MUKUL
Entity Type:Individual
Prefix:
First Name:VANDANA
Middle Name:MUKUL
Last Name:KEWALRAMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 NORTHCHASE PKWY SE
Mailing Address - Street 2:290
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 WESTBANK EXPY
Practice Address - Street 2:STE 345
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3615
Practice Address - Country:US
Practice Address - Phone:504-264-5307
Practice Address - Fax:678-247-7874
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA66471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice