Basic Information
| Provider Information | |||||||||
| NPI: | 1275888125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAVADI | ||||||||
| FirstName: | ELHAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5605 LAKEWOOD TOWNE CENTER BLVD SW | ||||||||
| Address2: | STE B | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532004706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8915 14TH AVE S FL 2 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981084813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067623263 | ||||||||
| FaxNumber: | 2067636574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | DE60232675 | WA | Y | Dental Providers | Dentist | Periodontics |
No ID Information.