Provider Demographics
NPI:1700330693
Name:NAKHWA, SAMRUDHI PRAKASH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMRUDHI
Middle Name:PRAKASH
Last Name:NAKHWA
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 1:808 2ND AVE APT KIRKLAND
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6029
Mailing Address - Country:US
Mailing Address - Phone:425-503-7828
Mailing Address - Fax:
Practice Address - Street 1:12616 RENTON AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-3711
Practice Address - Country:US
Practice Address - Phone:206-280-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606756961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice