Provider Demographics
NPI:1275888125
Name:JAVADI, ELHAM
Entity Type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:JAVADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 LAKEWOOD TOWNE CENTER BLVD SW
Mailing Address - Street 2:STE B
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3855
Mailing Address - Country:US
Mailing Address - Phone:253-200-4706
Mailing Address - Fax:
Practice Address - Street 1:8915 14TH AVE S FL 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4813
Practice Address - Country:US
Practice Address - Phone:206-762-3263
Practice Address - Fax:206-763-6574
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602326751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics