Provider Demographics
NPI:1689314452
Name:DR GAYATRI SUNDARARAJAN DDS INC
Entity Type:Organization
Organization Name:DR GAYATRI SUNDARARAJAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYATRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-335-7890
Mailing Address - Street 1:3351 EL CAMINO REAL STE 235
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3862
Mailing Address - Country:US
Mailing Address - Phone:608-335-7890
Mailing Address - Fax:
Practice Address - Street 1:3351 EL CAMINO REAL STE 235
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3862
Practice Address - Country:US
Practice Address - Phone:608-335-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101348OtherDENTAL