Provider Demographics
NPI:1902055056
Name:SITARAM DENTAL LLC
Entity Type:Organization
Organization Name:SITARAM DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SITARAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-506-8350
Mailing Address - Street 1:3780 W JONATHAN MOORE PIKE STE 180
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-9430
Mailing Address - Country:US
Mailing Address - Phone:317-506-8350
Mailing Address - Fax:
Practice Address - Street 1:3780 W JONATHAN MOORE PIKE STE 180
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-9430
Practice Address - Country:US
Practice Address - Phone:812-342-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-13
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010835A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental