Provider Demographics
NPI:1639374325
Name:LINGAM-NATTAMAI, YATHINDRAN J (DDS)
Entity Type:Individual
Prefix:MR
First Name:YATHINDRAN
Middle Name:J
Last Name:LINGAM-NATTAMAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 CORPORATE CENTER LN SE SUITE A
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-528-4488
Mailing Address - Fax:360-528-4490
Practice Address - Street 1:5511 CORPORATE CENTER LN SE SUITE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-528-4488
Practice Address - Fax:360-528-4490
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 79531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice