Provider Demographics
NPI:1104841923
Name:BAHL, RITU (DMD)
Entity Type:Individual
Prefix:DR
First Name:RITU
Middle Name:
Last Name:BAHL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 UNION BAY PL NE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4000
Mailing Address - Country:US
Mailing Address - Phone:206-524-2000
Mailing Address - Fax:206-400-2717
Practice Address - Street 1:4530 UNION BAY PL NE
Practice Address - Street 2:SUITE 207
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4000
Practice Address - Country:US
Practice Address - Phone:206-524-2000
Practice Address - Fax:206-400-2717
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice