Provider Demographics
NPI:1518511369
Name:ETIKALA, ANUSHA REDDY (BDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANUSHA
Middle Name:REDDY
Last Name:ETIKALA
Suffix:
Gender:F
Credentials:BDS, MS
Other - Prefix:DR
Other - First Name:ANUSHA
Other - Middle Name:REDDY
Other - Last Name:ETIKYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-365-5880
Mailing Address - Fax:206-365-6412
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-365-5880
Practice Address - Fax:206-365-6412
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608871851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics