Basic Information
| Provider Information | |||||||||
| NPI: | 1134321318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENGASAMY | ||||||||
| FirstName: | KANDASAMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 FARMINGTON AVENUE | ||||||||
| Address2: | UCONN SCHOOL OF DENTAL MEDICINE | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060302105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792207 | ||||||||
| FaxNumber: | 8606791899 | ||||||||
| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVENUE | ||||||||
| Address2: | UCONN SCHOOL OF DENTAL MEDICINE | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060302105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792476 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0008X | 010435 | CT | Y | Dental Providers | Dentist | Oral and Maxillofacial Radiology |
No ID Information.