| Porth | |
|
22620 Se 4th St Ste 210 Sammamish WA 98074-7375 | |
| (425) 526-2060 | |
| Not Available |
| Full Name | Porth |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 22620 Se 4th St Ste 210, Sammamish, Washington |
| Authorized Official Name and Position | Roozbeh Khosravi (ORTHODONTIST) |
| Authorized Official Contact | 6174669090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Porth 22620 Se 4th St Ste 210 Sammamish WA 98074-7375 Ph: (425) 526-2060 | Porth 22620 Se 4th St Ste 210 Sammamish WA 98074-7375 Ph: (425) 526-2060 |
| NPI Number | 1962913509 |
|---|---|
| Provider Enumeration Date | 10/23/2017 |
| Last Update Date | 10/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962913509 | NPI | - | NPPES |
| 1629433891 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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