Healthcare Provider Details

I. General information

NPI: 1629750211
Provider Name (Legal Business Name): ADITI VIMAWALA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 AVENUE D STE 100
SNOHOMISH WA
98290-2081
US

IV. Provider business mailing address

1825 148TH ST SE
MILL CREEK WA
98012-8206
US

V. Phone/Fax

Practice location:
  • Phone: 360-568-9694
  • Fax:
Mailing address:
  • Phone: 425-877-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61467175
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: