=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063775773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAILESH RAM PERSHAD D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2012
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 FORD ST
-----------------------------------------------------
City | OGDENSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13669-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-713-9350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 281 CLARE ST
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | K1Z7E3
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 056748
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------