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General NPI Number Information
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NPI Number | 1720522154
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Entity Type | Individual
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Provider Name | SHIVA SEYYADRI BDS
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Gender | Male
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Dates
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Enumeration Date | 12/04/2016
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 203 E DALKE AVE
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City | SPOKANE
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State | WA
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Zip | 99208-8112
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Country | US
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Telephone | 509-444-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 611 N IRON BRIDGE WAY
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City | SPOKANE
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State | WA
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Zip | 99202-4932
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Country | US
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Telephone | 509-444-8888
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Fax | 509-444-7806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60665197
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License Number State | WA
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