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25610 104th Ave Se Kent WA 98030-7610 | |
| (253) 850-9777 | |
| (253) 850-9757 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 25610 104th Ave Se, Kent, Washington |
| Authorized Official Name and Position | Ashifa A Nurani (PRESIDENT) |
| Authorized Official Contact | 7145786358 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
25610 104th Ave Se Kent WA 98030-7610 Ph: (253) 850-9777 | 25610 104th Ave Se Kent WA 98030-7610 Ph: (253) 850-9777 |
| NPI Number | 1053756049 |
|---|---|
| Provider Enumeration Date | 05/03/2013 |
| Last Update Date | 12/07/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053756049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DE00008078 (Washington) | Primary |
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Secondary |
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