Healthcare Provider Details

I. General information

NPI: 1770862377
Provider Name (Legal Business Name): KEYVAN SOHRABI ANARAKI DDS, MMSC, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 STATE ROUTE 9 NE
LAKE STEVENS WA
98258
US

IV. Provider business mailing address

709 STATE ROUTE 9 NE
LAKE STEVENS WA
98258-7992
US

V. Phone/Fax

Practice location:
  • Phone: 425-249-4129
  • Fax:
Mailing address:
  • Phone: 425-249-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE60334591
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: