Provider Demographics
NPI:1366546533
Name:ANNAMALAI, NADARAJAN (DMD)
Entity type:Individual
Prefix:DR
First Name:NADARAJAN
Middle Name:
Last Name:ANNAMALAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNAMALAI
Other - Middle Name:
Other - Last Name:NADARAJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1924D DAUPHIN ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-3004
Mailing Address - Country:US
Mailing Address - Phone:251-478-1181
Mailing Address - Fax:251-478-1125
Practice Address - Street 1:1924D DAUPHIN ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-3004
Practice Address - Country:US
Practice Address - Phone:251-478-1181
Practice Address - Fax:251-478-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist