=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285058131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOGESH GOEL,DMD,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2014
-----------------------------------------------------
Last Update Date | 02/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17705 140TH AVE NE SUITE A-14
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-947-2727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17705 140TH AVE NE SUITE A-14
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-947-2727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | YOGESH GOEL
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 617-763-4217
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE60127197
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------