Provider Demographics
NPI:1669836409
Name:GULRAJANI, SAMIKSHA (DMD)
Entity Type:Individual
Prefix:
First Name:SAMIKSHA
Middle Name:
Last Name:GULRAJANI
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 1:7718 19TH PL SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3212
Mailing Address - Country:US
Mailing Address - Phone:513-591-9747
Mailing Address - Fax:
Practice Address - Street 1:4418 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2397
Practice Address - Country:US
Practice Address - Phone:425-374-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0249801223G0001X
WADE61080297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice