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General NPI Number Information
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NPI Number | 1710186374
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Entity Type | Individual
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Provider Name | DAMAYANTHY SUNDARESAN DDS
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Gender | Female
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 77 MAIN ST
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City | MIDDLESEX
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State | NJ
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Zip | 08846-1513
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Country | US
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Telephone | 732-926-1234
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Fax | 732-926-8877
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Provider Business Mailing Address
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Address Line | 77 MAIN ST
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City | MIDDLESEX
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State | NJ
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Zip | 08846-1513
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Country | US
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Telephone | 732-926-1234
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Fax | 732-926-8877
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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 | 22DI0196400
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License Number State | NJ
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