Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DE 60121878 | WA |
NPI | 1023215902 |
---|---|
Provider Name | Aravind Buddula |
First Address | Redmond, WA 98052-3831 |
Second Address | Redmond, WA 98052-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 21/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
347453000 | (05) | MN |