Healthcare Provider Details

I. General information

NPI: 1871847368
Provider Name (Legal Business Name): RAMAMURTHY DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N CAPITOL AVE A1
SAN JOSE CA
95133-1913
US

IV. Provider business mailing address

750 N CAPITOL AVE A1
SAN JOSE CA
95133-1913
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-2090
  • Fax: 408-259-2027
Mailing address:
  • Phone: 408-259-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number58070
License Number StateCA

VIII. Authorized Official

Name: RAMYA RAMAMURTHY
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 408-259-2090