Provider Demographics
NPI:1336394337
Name:SETHU MADHAVAN, ASHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:
Last Name:SETHU MADHAVAN
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 1:22620 SE 4TH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7375
Mailing Address - Country:US
Mailing Address - Phone:425-802-5487
Mailing Address - Fax:
Practice Address - Street 1:22620 SE 4TH ST STE 230
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7375
Practice Address - Country:US
Practice Address - Phone:425-802-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60405871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA81-3682475OtherTIN