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General NPI Number Information
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NPI Number | 1912271776
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Entity Type | Organization
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Legal Business Name | GHAFGHAZI DDS,P.S.
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Dates
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Enumeration Date | 02/26/2012
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Last Update Date | 02/26/2012
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Provider Practice Location Address
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Address Line | 1002 PARK AVE N STE H
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City | RENTON
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State | WA
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Zip | 98057-5632
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Country | US
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Telephone | 617-605-5655
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Fax |
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Provider Business Mailing Address
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Address Line | 720 N 10TH ST # A-364
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City | RENTON
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State | WA
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Zip | 98057-5525
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAHRAM GHAFGHAZI
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Credential | DDS
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Telephone | 617-605-5655
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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 | DE 00010518
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License Number State | WA
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