Provider Demographics
NPI:1518030600
Name:RAJARAM, PADMAVATHI (DMD)
Entity Type:Individual
Prefix:
First Name:PADMAVATHI
Middle Name:
Last Name:RAJARAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPRUCE ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2474
Mailing Address - Country:US
Mailing Address - Phone:206-461-6935
Mailing Address - Fax:206-461-8382
Practice Address - Street 1:3800 S MYRTLE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3529
Practice Address - Country:US
Practice Address - Phone:206-461-6981
Practice Address - Fax:206-461-8581
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000092031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5037874Medicaid