Most Relevant Information
Provider Data
| NPI Number: | 1003548611 |
| Provider Name: | HEERA GOVINDARAJAN VENGUIDESVARANE DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | DE61326176 |
Most Important Dates
| Enumeration Date: | 06/30/2022 |
| Last Updated: | 06/17/2024 |
Provider Practice Location
1515 E COLUMBIA ST
OTHELLO
WA
993441846
Practice Location Phone/Fax
| Phone: | 5094885256 |
| Fax: | 5094889939 |
Provider Mailing Location
1515 E COLUMBIA ST
OTHELLO
WA
993441846
Provider Mailing Phone/Fax
| Phone: | 5094885256 |
| Fax: | 5094889939 |