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General NPI Number Information
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NPI Number | 1255220141
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Entity Type | Organization
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Legal Business Name | VARTAK DDS PLLC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1200 STATION DR STE 180
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City | DUPONT
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State | WA
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Zip | 98327-9804
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Country | US
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Telephone | 818-726-4287
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Fax |
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Provider Business Mailing Address
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Address Line | 677 S LOWELL ST APT 252
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City | PORTLAND
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State | OR
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Zip | 97239-4817
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Country | US
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Telephone | 818-726-4287
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | MANJIRI VARTAK
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Credential | DDS
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Telephone | 818-726-4287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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