=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508337619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSANA BISHAI DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2018
-----------------------------------------------------
Last Update Date | 12/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12835 NEWCASTLE WAY SUITE 304
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98056-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-441-7704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5624 117TH AVE SE
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98006-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-985-3583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROSANA BISHAI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 425-985-3583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------