Provider Demographics
NPI:1386324044
Name:NAMATHIRTHAM, SHALINI
Entity type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:NAMATHIRTHAM
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 1:304 CHESTNUT PKWY APT 8313
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3864
Mailing Address - Country:US
Mailing Address - Phone:952-649-7690
Mailing Address - Fax:
Practice Address - Street 1:2858 W HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8434
Practice Address - Country:US
Practice Address - Phone:704-220-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist