Healthcare Provider Details

I. General information

NPI: 1902777048
Provider Name (Legal Business Name): MUKTAI ABHAY DESHPANDE BDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 100TH AVE NE STE 110
KIRKLAND WA
98034-5209
US

IV. Provider business mailing address

9742 NE 119TH WAY APT D314
KIRKLAND WA
98034-8948
US

V. Phone/Fax

Practice location:
  • Phone: 425-654-1087
  • Fax:
Mailing address:
  • Phone: 424-535-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDENT.DE.70030865
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: