Provider Demographics
NPI:1134313844
Name:MISTRY, PRIYA PATIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:PATIL
Last Name:MISTRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PRITI
Other - Middle Name:SHASHIKANT
Other - Last Name:PATIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:18207 SE 20TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1800
Mailing Address - Country:US
Mailing Address - Phone:425-256-0481
Mailing Address - Fax:
Practice Address - Street 1:7931 NE HALSEY ST STE 307
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6793
Practice Address - Country:US
Practice Address - Phone:503-255-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601997951223G0001X
ORD109701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice