Healthcare Provider Details

I. General information

NPI: 1528707205
Provider Name (Legal Business Name): KHUSHBU RAVAL RDH BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 112TH AVE NE STE 100
BELLEVUE WA
98004-3718
US

IV. Provider business mailing address

1418 112TH AVE NE STE 100
BELLEVUE WA
98004-3718
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00007499
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: