Provider Demographics
NPI:1114561958
Name:PATIL, AISHWARYA VIJAY (DDS)
Entity Type:Individual
Prefix:
First Name:AISHWARYA
Middle Name:VIJAY
Last Name:PATIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 NE 133RD PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3306
Mailing Address - Country:US
Mailing Address - Phone:562-881-3721
Mailing Address - Fax:
Practice Address - Street 1:12911 120TH AVE NE STE F200
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3026
Practice Address - Country:US
Practice Address - Phone:425-821-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60977967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist