Healthcare Provider Details

I. General information

NPI: 1114014925
Provider Name (Legal Business Name): NEETHA RAVINDRA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 LIVINGSTON AVE DENTAL HEALTH ASSOCIATES PA
NORTH BRUNSWICK NJ
08902
US

IV. Provider business mailing address

320 SOUTH MAIN STREET DENTAL HEALTH ASSOCIATES PA CORPORATE OFFICE 2ND FLR
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 732-418-9800
  • Fax: 732-418-0046
Mailing address:
  • Phone: 908-387-6120
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI019956
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: