Healthcare Provider Details

I. General information

NPI: 1750903894
Provider Name (Legal Business Name): BRENDA STEPHANIE RAMOS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 HUDSON AVE
ROCHESTER NY
14617-4300
US

IV. Provider business mailing address

400 LIBERTY AVE
ROCHESTER NY
14622-1956
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2800
  • Fax:
Mailing address:
  • Phone: 978-979-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number062315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: