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General NPI Number Information
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NPI Number | 1962913509
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Entity Type | Organization
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Legal Business Name | ROOZBEH KHOSRAVI DMD PHD LLC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 22620 SE 4TH ST STE 210
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City | SAMMAMISH
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State | WA
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Zip | 98074-7375
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Country | US
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Telephone | 425-526-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 22620 SE 4TH ST STE 210
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City | SAMMAMISH
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State | WA
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Zip | 98074-7375
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Country | US
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Telephone | 425-526-2060
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. ROOZBEH KHOSRAVI
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Credential | DMD PHD MSD
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Telephone | 617-466-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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