Healthcare Provider Details

I. General information

NPI: 1306803499
Provider Name (Legal Business Name): NEERAJA NARAYANAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SOCIAL ST THUNDERMIST HEALTH CENTER
WOONSOCKET RI
02895
US

IV. Provider business mailing address

191 SOCIAL ST THUNDERMIST HEALTH CENTER
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4161
  • Fax: 401-767-4165
Mailing address:
  • Phone: 401-767-4163
  • Fax: 401-767-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN02812
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: