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General NPI Number Information
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NPI Number | 1003359886
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Entity Type | Individual
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Provider Name | RAGHAVANAND SUNDARESH
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Gender | Male
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 620 N CHURCH ST STE 113
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City | CHARLOTTE
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State | NC
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Zip | 28202-3277
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Country | US
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Telephone | 704-773-3771
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 701031
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City | CHARLOTTE
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State | NC
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Zip | 28216
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Country | US
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Telephone | 704-773-3771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10542
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License Number State | NC
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