Provider Demographics
NPI:1407588684
Name:SUMAN, SANGHAMITRA
Entity Type:Individual
Prefix:DR
First Name:SANGHAMITRA
Middle Name:
Last Name:SUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 82ND ST SW APT 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-7289
Mailing Address - Country:US
Mailing Address - Phone:206-384-2902
Mailing Address - Fax:
Practice Address - Street 1:2728 WESTMOOR CT SW STE D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5779
Practice Address - Country:US
Practice Address - Phone:360-995-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE.61303997122300000X
122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No122400000XDental ProvidersDenturist