MEDICARE: DR. ASHA SETHU MADHAVAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE60405871	WA

General Provider Information

NPI Number	:	1336394337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHA SETHU MADHAVAN D.D.S.

Provider Business Mailing Address
First Line	:	22620 SE 4TH ST STE 230
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7375
Country	:	US
Telephone Number	:	425-802-5487
Fax Number	:

Provider Business Practice Location Address
First Line	:	22620 SE 4TH ST STE 230
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7375
Country	:	US
Telephone Number	:	425-802-5487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	07/21/2022

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