Provider Demographics
NPI:1447092762
Name:SUBRAMANYAM, SHALINI (DDS)
Entity type:Individual
Prefix:DR
First Name:SHALINI
Middle Name:
Last Name:SUBRAMANYAM
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 1:3769 PRESIDENTS LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-5508
Mailing Address - Country:US
Mailing Address - Phone:414-400-2268
Mailing Address - Fax:
Practice Address - Street 1:4401 E 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-2744
Practice Address - Country:US
Practice Address - Phone:317-399-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014473A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist