Provider Demographics
NPI:1275192759
Name:DR. PRANAY GULATI
Entity Type:Organization
Organization Name:DR. PRANAY GULATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-525-4312
Mailing Address - Street 1:2719 HEFNER AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2014
Mailing Address - Country:US
Mailing Address - Phone:360-525-4312
Mailing Address - Fax:
Practice Address - Street 1:9395 LINDER WAY NW STE 102
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9149
Practice Address - Country:US
Practice Address - Phone:360-525-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891167219Medicaid