Healthcare Provider Details

I. General information

NPI: 1740536333
Provider Name (Legal Business Name): PARTH MEWAR DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LINCOLN ST 2ND FLOOR
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9900 LINCOLN ST 2ND FLOOR
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4039
  • Fax: 253-968-5919
Mailing address:
  • Phone: 253-968-4039
  • Fax: 253-968-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number31647
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: