Healthcare Provider Details

I. General information

NPI: 1114578069
Provider Name (Legal Business Name): JAVID OSAFI DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19020 BOTHELL WAY NE STE C
BOTHELL WA
98011-2996
US

IV. Provider business mailing address

324 102ND AVE SE APT 308
BELLEVUE WA
98004-8109
US

V. Phone/Fax

Practice location:
  • Phone: 425-659-1200
  • Fax: 425-659-3131
Mailing address:
  • Phone: 425-223-3522
  • Fax: 425-659-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAVID FARAN OSAFI
Title or Position: DENTIST / OWNER
Credential: DMD
Phone: 425-223-3522