Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10542 | NC |
NPI | 1003359886 |
---|---|
Provider Name | Raghav Sundaresh |
First Address | Charlotte, NC 28216 |
Second Address | Charlotte, NC 28216-4632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 28/11/2016 |