Provider Demographics
NPI:1386925477
Name:SUBEDAR, ASHOKA (DMD)
Entity type:Individual
Prefix:DR
First Name:ASHOKA
Middle Name:
Last Name:SUBEDAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S 15TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4570
Mailing Address - Country:US
Mailing Address - Phone:360-424-9860
Mailing Address - Fax:360-424-9861
Practice Address - Street 1:230 S 15TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4570
Practice Address - Country:US
Practice Address - Phone:360-424-9860
Practice Address - Fax:360-424-9861
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1548375124OtherNPI ORGANIZATION