Provider Demographics
NPI:1215657465
Name:RAMANATHAN, SHWETHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHWETHA
Middle Name:
Last Name:RAMANATHAN
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 1:8717 BLAZE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-3730
Mailing Address - Country:US
Mailing Address - Phone:468-286-7992
Mailing Address - Fax:
Practice Address - Street 1:4410 E RIVERSIDE DR STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-4759
Practice Address - Country:US
Practice Address - Phone:512-256-8754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist