Provider Demographics
NPI:1528420684
Name:SUNDARARAJAN, GAYATRI (DDS)
Entity type:Individual
Prefix:
First Name:GAYATRI
Middle Name:
Last Name:SUNDARARAJAN
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 1:38883 VIENTO CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4455
Mailing Address - Country:US
Mailing Address - Phone:608-335-7890
Mailing Address - Fax:
Practice Address - Street 1:3351 EL CAMINO REAL STE 235
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3862
Practice Address - Country:US
Practice Address - Phone:608-335-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist