Healthcare Provider Details

I. General information

NPI: 1134676554
Provider Name (Legal Business Name): FACTORIA DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 FACTORIA BLVD SE STE 1
BELLEVUE WA
98006-1936
US

IV. Provider business mailing address

4307 FACTORIA BLVD SE STE 1
BELLEVUE WA
98006-1936
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-8788
  • Fax:
Mailing address:
  • Phone: 425-747-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HASSAN CHIHAB
Title or Position: OWNER DENTIST
Credential:
Phone: 425-747-8778