Individual
LAVANYA RAJENDRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
190 HEMPSTEAD ST, NEW LONDON, CT 06320-6248
(860) 443-2428
Mailing address
25 COPPER BEECH DR, CHESHIRE, CT 06410-2950
(203) 379-7006
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
13249
CT
1223P0300X
Periodontics
DEN03625
RI
390200000X
Student in an Organized Health Care Education/Training Program
12212
CT
Other
Enumeration date
03/09/2018
Last updated
11/01/2022
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