Provider Demographics
NPI:1174746622
Name:VANAMA, MADHURI (DDS)
Entity type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:VANAMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23349 SE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6811
Mailing Address - Country:US
Mailing Address - Phone:425-427-8215
Mailing Address - Fax:
Practice Address - Street 1:23349 SE 52ND ST
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6811
Practice Address - Country:US
Practice Address - Phone:425-427-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist