Provider Demographics
NPI:1316199862
Name:ASTUTO, ARUNA RAJAGOPALAN (DDS)
Entity Type:Individual
Prefix:
First Name:ARUNA
Middle Name:RAJAGOPALAN
Last Name:ASTUTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3308
Mailing Address - Country:US
Mailing Address - Phone:636-239-6328
Mailing Address - Fax:636-239-5048
Practice Address - Street 1:1111 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3308
Practice Address - Country:US
Practice Address - Phone:636-239-6328
Practice Address - Fax:636-239-5048
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080168901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008016890OtherMISSOURI DENTAL LICENSE NUMBER