Provider Demographics
NPI:1326249731
Name:PADMARAJ V. ANGOLKAR D.D.S., M.D.S.
Entity Type:Organization
Organization Name:PADMARAJ V. ANGOLKAR D.D.S., M.D.S.
Other - Org Name:ANGOLKAR 4 SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PADMARAJ (RAJ)
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANGOLKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:425-392-0980
Mailing Address - Street 1:505 E SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3438
Mailing Address - Country:US
Mailing Address - Phone:425-392-0980
Mailing Address - Fax:425-392-0671
Practice Address - Street 1:505 E SUNSET WAY
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3438
Practice Address - Country:US
Practice Address - Phone:425-392-0980
Practice Address - Fax:425-392-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000057811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty