Healthcare Provider Details

I. General information

NPI: 1326692013
Provider Name (Legal Business Name): GENTAI NI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11216 NE 15TH ST STE A
BELLEVUE WA
98004-3724
US

IV. Provider business mailing address

11216 NE 15TH ST STE A
BELLEVUE WA
98004-3724
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-3221
  • Fax: 888-299-5920
Mailing address:
  • Phone: 425-454-3221
  • Fax: 888-299-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61007817
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61007817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: