Healthcare Provider Details

I. General information

NPI: 1902259468
Provider Name (Legal Business Name): NORTHGATE ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 MERIDIAN AVE N SUITE 309
SEATTLE WA
98133-8967
US

IV. Provider business mailing address

11011 MERIDIAN AVE N SUITE 309
SEATTLE WA
98133-8967
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-5500
  • Fax: 206-367-5501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6882
License Number StateWA

VIII. Authorized Official

Name: DR. SHAHRZAD SARRAM
Title or Position: ENDODONTIST
Credential: D.D.S., M.S.D.
Phone: 206-367-5500