Individual
HEERA GOVINDARAJAN VENGUIDESVARANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE61326176
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE61326176
DOH LICENSE
WA
Enumeration date
06/30/2022
Last updated
06/17/2024
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