Provider Demographics
NPI:1508995176
Name:NARRA, SASIDHAR R (MDS, BDS)
Entity Type:Individual
Prefix:DR
First Name:SASIDHAR
Middle Name:R
Last Name:NARRA
Suffix:
Gender:M
Credentials:MDS, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 NW JUNIPER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-391-8284
Mailing Address - Fax:425-391-7313
Practice Address - Street 1:710 NW JUNIPER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-391-8284
Practice Address - Fax:425-391-7313
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000108351223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery