Healthcare Provider Details

I. General information

NPI: 1760714943
Provider Name (Legal Business Name): VIKRAM LIKHARI BDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 BEL RED RD STE 101
BELLEVUE WA
98007-3930
US

IV. Provider business mailing address

9925 NE 1ST ST APT #28
BELLEVUE WA
98004-5652
US

V. Phone/Fax

Practice location:
  • Phone: 617-512-4412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00010984
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: