Provider Demographics
NPI:1043872203
Name:NERAL, TEJA KOTRESH
Entity Type:Individual
Prefix:
First Name:TEJA
Middle Name:KOTRESH
Last Name:NERAL
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 1:509 OLIVE WAY STE 1230
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1745
Mailing Address - Country:US
Mailing Address - Phone:206-622-6693
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1230
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1745
Practice Address - Country:US
Practice Address - Phone:206-622-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60962950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist