Healthcare Provider Details

I. General information

NPI: 1669028296
Provider Name (Legal Business Name): SUMAN RAMAKUMAR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 FREMONT BLVD STE E2
SEASIDE CA
93955-4319
US

IV. Provider business mailing address

1513 FREMONT BLVD STE E2
SEASIDE CA
93955-4319
US

V. Phone/Fax

Practice location:
  • Phone: 831-204-6413
  • Fax:
Mailing address:
  • Phone: 831-324-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SUMAN A RAMAKUMAR
Title or Position: OWNER/DENTIST
Credential:
Phone: 408-656-0969