Healthcare Provider Details

I. General information

NPI: 1174048623
Provider Name (Legal Business Name): ISHRAQ ALSHANQITI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2017
Last Update Date: 08/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

12311 32ND AVE NE APT 317
SEATTLE WA
98125-5588
US

V. Phone/Fax

Practice location:
  • Phone: 206-685-2937
  • Fax:
Mailing address:
  • Phone: 206-229-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0000000000000
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: