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General NPI Number Information
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NPI Number | 1831692425
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Entity Type | Individual
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Provider Name | LAVANYA RAJENDRAN DMD
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Gender | Female
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 190 HEMPSTEAD ST
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City | NEW LONDON
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State | CT
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Zip | 06320-6248
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Country | US
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Telephone | 860-443-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 25 COPPER BEECH DR
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City | CHESHIRE
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State | CT
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Zip | 06410-2950
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Country | US
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Telephone | 203-379-7006
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DEN03625
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 12212
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 13249
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License Number State | CT
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