Healthcare Provider Details

I. General information

NPI: 1346796141
Provider Name (Legal Business Name): SUNEET S BATH D M D P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 MARTIN WAY E STE 103
OLYMPIA WA
98516-5387
US

IV. Provider business mailing address

4538 MARTIN WAY E STE 103
OLYMPIA WA
98516-5387
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-1866
  • Fax:
Mailing address:
  • Phone: 360-493-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9299
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SUNEET S BATH
Title or Position: OWNER
Credential: D.D.S
Phone: 360-493-1866