Provider Demographics
NPI:1861832446
Name:PULLAT, ANAND (DDS, MHA)
Entity Type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:PULLAT
Suffix:
Gender:M
Credentials:DDS, MHA
Other - Prefix:DR
Other - First Name:TWINKLE
Other - Middle Name:
Other - Last Name:ANAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MHA
Mailing Address - Street 1:126 SW 148TH ST STE C100-212
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1984
Mailing Address - Country:US
Mailing Address - Phone:917-913-6096
Mailing Address - Fax:
Practice Address - Street 1:14212 AMBAUM BLVD SW STE 1
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1437
Practice Address - Country:US
Practice Address - Phone:206-343-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3821-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05635067Medicaid