Provider Demographics
NPI:1518028109
Name:NETTEM, MADHAVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:
Last Name:NETTEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WARREN ST
Mailing Address - Street 2:#101
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1578
Mailing Address - Country:US
Mailing Address - Phone:650-366-1116
Mailing Address - Fax:
Practice Address - Street 1:401 WARREN ST #101
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-366-1116
Practice Address - Fax:650-363-1116
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice