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General NPI Number Information
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NPI Number | 1407191265
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Entity Type | Organization
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Legal Business Name | ISSAQUAH VALLEY DENTAL CARE
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 1660 NW GILMAN BLVD SUITE C1
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City | ISSAQUAH
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State | WA
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Zip | 98027-5340
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Country | US
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Telephone | 425-392-4122
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Fax | 425-392-1167
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Provider Business Mailing Address
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Address Line | 1660 NW GILMAN BLVD SUITE C1
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City | ISSAQUAH
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State | WA
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Zip | 98027-5340
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Country | US
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Telephone | 425-392-4122
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Fax | 425-392-1167
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AJAY DHANKHAR
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Credential | DDS
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Telephone | 425-392-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00009838
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00009509
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License Number State | WA
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