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General NPI Number Information
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NPI Number | 1871745588
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Entity Type | Individual
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Provider Name | SHRADHA BANSAL DDS
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Gender | Female
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 85 NW ALDER PL STE B
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City | ISSAQUAH
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State | WA
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Zip | 98027-3201
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Country | US
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Telephone | 425-657-0609
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Fax | 866-528-2025
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Provider Business Mailing Address
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Address Line | 615 WINDSOR DR SE
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City | SAMMAMISH
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State | WA
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Zip | 98074-3422
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Country | US
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Telephone | 425-830-4773
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE00008920
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License Number State | WA
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