Provider Demographics
NPI:1528815123
Name:THANGAMANI NADAR, KARTHICK
Entity type:Individual
Prefix:
First Name:KARTHICK
Middle Name:
Last Name:THANGAMANI NADAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14814 NW EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7030
Mailing Address - Country:US
Mailing Address - Phone:669-237-5164
Mailing Address - Fax:
Practice Address - Street 1:4071 LEE RD STE 260
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2173
Practice Address - Country:US
Practice Address - Phone:216-727-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0047451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice