MEDICARE: FREMONT FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7667	WA

General Provider Information

NPI Number	:	1326194218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREMONT FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	4464 FREMONT AVE N
Second Line	:	SUITE 103
City	:	SEATTLE
State	:	WA
Zip	:	98103-7273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4464 FREMONT AVE N
Second Line	:	SUITE 103
City	:	SEATTLE
State	:	WA
Zip	:	98103-7273
Country	:	US
Telephone Number	:	206-267-7300
Fax Number	:

Authorized Official
Title or Position	:	DENTIS
Name	:	MAHVASH KHAJAVI-HARVEY
Credential	:
Telephone Number	:	206-267-7300

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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Directions to “FREMONT FAMILY DENTISTRY ” Practice Location

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