Provider Demographics
NPI:1538198320
Name:RAMPULLA, MICHELLE KENNEDY (DDS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KENNEDY
Last Name:RAMPULLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 PEARTREE LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2643
Mailing Address - Country:US
Mailing Address - Phone:410-721-6955
Mailing Address - Fax:
Practice Address - Street 1:7939 HONEYGO BLVD
Practice Address - Street 2:SUITE 227
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4931
Practice Address - Country:US
Practice Address - Phone:410-931-0250
Practice Address - Fax:410-931-4876
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics