Provider Demographics
NPI:1548950207
Name:RADHAKRISHNAN, RASHMI
Entity type:Individual
Prefix:
First Name:RASHMI
Middle Name:
Last Name:RADHAKRISHNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 CARAWAY LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-9232
Mailing Address - Country:US
Mailing Address - Phone:205-789-3878
Mailing Address - Fax:
Practice Address - Street 1:3150 ZELDA CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2607
Practice Address - Country:US
Practice Address - Phone:334-281-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007201-C1122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist