Provider Demographics
NPI:1255096970
Name:SATHYAMOORTHY, THAMIZHVANI (DDS)
Entity type:Individual
Prefix:
First Name:THAMIZHVANI
Middle Name:
Last Name:SATHYAMOORTHY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6674 GREEN RIVER DR UNIT H
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-3001
Mailing Address - Country:US
Mailing Address - Phone:729-520-2957
Mailing Address - Fax:
Practice Address - Street 1:6674 GREEN RIVER DR UNIT H
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-3001
Practice Address - Country:US
Practice Address - Phone:720-520-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX380011223G0001X
CODEN00204857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice