=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689800096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOGESH GOEL DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2009
-----------------------------------------------------
Last Update Date | 02/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17705 140TH AVE NE SUITE A-14
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-763-4217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3645 115TH AVE NE H309
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-7818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-763-4217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE60127197
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------