Provider Demographics
NPI:1578682092
Name:SUBRAMANIAM, KRISHNAMOORTHY (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISHNAMOORTHY
Middle Name:
Last Name:SUBRAMANIAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-01 MIDLAND PKWY LOBBY-D
Mailing Address - Street 2:
Mailing Address - City:JAMAICA ESTATES
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-526-7339
Mailing Address - Fax:718-526-7339
Practice Address - Street 1:87-01 MIDLAND PKWY
Practice Address - Street 2:LOBBY-D
Practice Address - City:JAMAICA ESTATES
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-526-7339
Practice Address - Fax:718-526-7339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist