Provider Demographics
NPI:1174011464
Name:SATYAWATI POTARAJU DDS LLC
Entity Type:Organization
Organization Name:SATYAWATI POTARAJU DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-445-8800
Mailing Address - Street 1:1151 S HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206
Mailing Address - Country:US
Mailing Address - Phone:614-445-8800
Mailing Address - Fax:614-445-0803
Practice Address - Street 1:1151 S HIGH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206
Practice Address - Country:US
Practice Address - Phone:614-445-8800
Practice Address - Fax:614-445-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty