Individual
MRS. SULAKSHANA SUNDARESAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
60 CHURCH STREET, YALESVILLE, CT 06492
(203) 774-0019
(203) 774-0034
Mailing address
60 CHURCH STREET, YALESVILLE, CT 06492
(203) 774-0019
(203) 774-0034
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
9656
CT
1223G0001X
General Practice Dentistry
Primary
9656
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MCD008001178
—
CT
Enumeration date
09/25/2008
Last updated
09/24/2010
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