Provider Demographics
NPI:1316327349
Name:NAGARAJU, SWETHA T
Entity type:Individual
Prefix:
First Name:SWETHA
Middle Name:T
Last Name:NAGARAJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 METCALF AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2804
Mailing Address - Country:US
Mailing Address - Phone:913-851-5110
Mailing Address - Fax:913-851-0321
Practice Address - Street 1:13316 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2804
Practice Address - Country:US
Practice Address - Phone:913-851-5110
Practice Address - Fax:913-851-0321
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015017431122300000X
KS611581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist