Provider Demographics
NPI:1972718237
Name:RAMANAN, AISHWARYA
Entity type:Individual
Prefix:
First Name:AISHWARYA
Middle Name:
Last Name:RAMANAN
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 1:14410 SE PETROVITSKY RD STE 113
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8900
Mailing Address - Country:US
Mailing Address - Phone:425-271-7725
Mailing Address - Fax:425-271-3018
Practice Address - Street 1:14410 SE PETROVITSKY RD STE 113
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8900
Practice Address - Country:US
Practice Address - Phone:425-271-7725
Practice Address - Fax:425-271-3018
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA97831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice