Provider Demographics
NPI:1114335379
Name:RAMADURGAM, SUNDARA (DDS)
Entity Type:Individual
Prefix:
First Name:SUNDARA
Middle Name:
Last Name:RAMADURGAM
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 1:14212 AMBAUM BLVD SW STE 1
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1437
Mailing Address - Country:US
Mailing Address - Phone:206-343-0000
Mailing Address - Fax:
Practice Address - Street 1:14212 AMBAUM BLVD SW STE 1
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-343-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019122300000X
NV6857122300000X
WA60889681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist