Provider Demographics
NPI:1073771838
Name:RAJU, NITIN UDDARAJU (DDS)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:UDDARAJU
Last Name:RAJU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 PECAN TREE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1865
Mailing Address - Country:US
Mailing Address - Phone:210-416-0688
Mailing Address - Fax:
Practice Address - Street 1:235 E HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2430
Practice Address - Country:US
Practice Address - Phone:210-824-4501
Practice Address - Fax:210-824-0125
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery