Provider Demographics
NPI:1477543932
Name:SIVARAMAN, SUJATHA SEKAR (DMD)
Entity type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:SEKAR
Last Name:SIVARAMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 W WORLEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2475 BROADWAY BLUFFS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8148
Practice Address - Country:US
Practice Address - Phone:573-777-9282
Practice Address - Fax:573-777-9569
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050266191223P0221X
MO20240085181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry