Provider Demographics
NPI:1346649472
Name:TULADHAR, RAJIV (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:TULADHAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2111
Mailing Address - Country:US
Mailing Address - Phone:877-761-7355
Mailing Address - Fax:
Practice Address - Street 1:3400 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2111
Practice Address - Country:US
Practice Address - Phone:877-761-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18566651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice