Provider Demographics
NPI:1528230521
Name:SUNDARAM, PREETHI (DDS)
Entity Type:Individual
Prefix:
First Name:PREETHI
Middle Name:
Last Name:SUNDARAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SREEPREETHI
Other - Middle Name:
Other - Last Name:GNANASUNDARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2613
Mailing Address - Country:US
Mailing Address - Phone:732-651-6272
Mailing Address - Fax:
Practice Address - Street 1:43490 YUKON DRIVE SUITE114
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:732-735-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014129931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice