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General NPI Number Information
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NPI Number | 1275989196
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Entity Type | Organization
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Legal Business Name | AA BANSAL 2
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 615 WINDSOR DR SE
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City | SAMMAMISH
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State | WA
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Zip | 98074-3422
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Country | US
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Telephone | 253-326-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 615 WINDSOR DR SE
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City | SAMMAMISH
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State | WA
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Zip | 98074-3422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHRADHA BANSAL
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Credential | DDS
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Telephone | 425-891-2461
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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 | 8920
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License Number State | WA
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