Healthcare Provider Details

I. General information

NPI: 1972546646
Provider Name (Legal Business Name): AJEY VARMA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 S. UNION AVE. #B-17
TACOMA WA
98405
US

IV. Provider business mailing address

2302 S. UNION AVE. #B-17
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-6915
  • Fax: 253-752-9003
Mailing address:
  • Phone: 253-752-6915
  • Fax: 253-752-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0251037764
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: