Healthcare Provider Details

I. General information

NPI: 1770021172
Provider Name (Legal Business Name): KARTHIKEYAN SUBRAMANI B.D.S., M.SC., M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SUNSET WAY STE C ROSEMAN UNIVERSITY OF HEALTH SCIENCES
HENDERSON NV
89014-2016
US

IV. Provider business mailing address

1072 VIA DELLA COSTRELLA
HENDERSON NV
89011-0955
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-7054
  • Fax: 702-968-5277
Mailing address:
  • Phone: 859-797-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberLL-439-16
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: