Provider Demographics
NPI:1336631514
Name:SUGANYA NELATOOR,D.D.S.,P.L.L.C.
Entity Type:Organization
Organization Name:SUGANYA NELATOOR,D.D.S.,P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUGANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELATOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-400-5975
Mailing Address - Street 1:102 E WAXHAW PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 E WAXHAW PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:703-400-5375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09619261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental