Provider Demographics
NPI:1699203612
Name:VASUDEVAN, PARIDHIE (DMD)
Entity Type:Individual
Prefix:
First Name:PARIDHIE
Middle Name:
Last Name:VASUDEVAN
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 1:1638 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9373
Mailing Address - Country:US
Mailing Address - Phone:321-626-0925
Mailing Address - Fax:
Practice Address - Street 1:7207 ENGLE RD STE 2
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2231
Practice Address - Country:US
Practice Address - Phone:260-632-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225141223G0001X
IN12013174A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice