Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE60034827 | WA |
NPI | 1003062845 |
---|---|
Provider Name | Dr. Dipti Srivastava |
First Address | Redmond, WA 98052-5459 |
Second Address | Auburn, WA 98002-4013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 19/08/2016 |