Provider Demographics
NPI:1902459035
Name:HOSAPURA SHESHAGIRI, PRIYANKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:HOSAPURA SHESHAGIRI
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 1:7650 SE 27TH ST UNIT 642
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3070
Mailing Address - Country:US
Mailing Address - Phone:917-865-9081
Mailing Address - Fax:
Practice Address - Street 1:7650 SE 27TH ST UNIT 642
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3070
Practice Address - Country:US
Practice Address - Phone:917-865-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60966859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist