MEDICARE: SUMAN RAMAKUMAR DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry
3	1223P0300X	Periodontics
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
5	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
6	122300000X	Dentist

General Provider Information

NPI Number	:	1508412131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMAN RAMAKUMAR DDS INC

Provider Business Mailing Address
First Line	:	1180 BLOSSOM HILL RD STE 4
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-3114
Country	:	US
Telephone Number	:	408-872-9463
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 BLOSSOM HILL RD STE 4
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-3114
Country	:	US
Telephone Number	:	408-872-9463
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	SUMAN A RAMAKUMAR
Credential	:
Telephone Number	:	408-900-6361

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	02/12/2021

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