MEDICARE: DR. ANGELA SHANTHINI RATNAM D.D.S.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	D5589	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891888772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA SHANTHINI RATNAM D.D.S.

Provider Business Mailing Address
First Line	:	1245 E SOUTHERN AVE
Second Line	:	STE 12
City	:	MESA
State	:	AZ
Zip	:	85204-5137
Country	:	US
Telephone Number	:	480-610-6544
Fax Number	:	480-633-0670

Provider Business Practice Location Address
First Line	:	1245 E SOUTHERN AVE
Second Line	:	STE 12
City	:	MESA
State	:	AZ
Zip	:	85204-5137
Country	:	US
Telephone Number	:	480-610-6544
Fax Number	:	480-633-0670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/09/2007

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