Healthcare Provider Details

I. General information

NPI: 1467668608
Provider Name (Legal Business Name): SMITA PATEL DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 201ST PL SE APT 201
BOTHELL WA
98012-8572
US

IV. Provider business mailing address

1908 201ST PL SE APT 201
BOTHELL WA
98012-8572
US

V. Phone/Fax

Practice location:
  • Phone: 206-658-3329
  • Fax: 425-491-7233
Mailing address:
  • Phone: 206-658-3329
  • Fax: 425-491-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00010731
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDE00010731
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: