Provider Demographics
NPI:1235541467
Name:MADURANTAKAM, PARTHASARATHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARTHASARATHY
Middle Name:
Last Name:MADURANTAKAM
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 1:4440 SPRINGFIELD RD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3410
Mailing Address - Country:US
Mailing Address - Phone:804-217-9820
Mailing Address - Fax:804-217-9822
Practice Address - Street 1:4440 SPRINGFIELD RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3410
Practice Address - Country:US
Practice Address - Phone:804-217-9820
Practice Address - Fax:804-217-9822
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice