Healthcare Provider Details

I. General information

NPI: 1427407840
Provider Name (Legal Business Name): SANTOSHIRATNAM KEDARSETTY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42707 N RIDGE RD
ELYRIA OH
44035-1054
US

IV. Provider business mailing address

7824 NORMANDIE BLVD APT K87
MIDDLEBURG HEIGHTS OH
44130-6916
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-3441
  • Fax: 440-324-3488
Mailing address:
  • Phone: 937-546-8997
  • Fax: 440-654-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3024794
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9856
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: