Healthcare Provider Details

I. General information

NPI: 1659492718
Provider Name (Legal Business Name): MINOU KARBAKHSCH D.D.S., M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 SO. UNION AVE. SUITE C-22
TACOMA WA
98405
US

IV. Provider business mailing address

2302 SO. UNION AVE. SUITE C-22
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-6336
  • Fax: 253-752-5655
Mailing address:
  • Phone: 253-752-6336
  • Fax: 253-752-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8579
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: