Provider Demographics
NPI:1477946192
Name:SELVA RATHAKRISHNAN, SAKTHI PAVITHRA
Entity Type:Individual
Prefix:
First Name:SAKTHI PAVITHRA
Middle Name:
Last Name:SELVA RATHAKRISHNAN
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 1:18100 NE 95TH ST
Mailing Address - Street 2:#EE2028
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6931
Mailing Address - Country:US
Mailing Address - Phone:425-241-0957
Mailing Address - Fax:
Practice Address - Street 1:18100 NE 95TH ST
Practice Address - Street 2:#EE2028
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6931
Practice Address - Country:US
Practice Address - Phone:425-241-0957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant