Provider Demographics
NPI:1285180513
Name:MATTU, AMRITPAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMRITPAL
Middle Name:
Last Name:MATTU
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 1:673 KITSAP AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-8589
Mailing Address - Country:US
Mailing Address - Phone:425-753-1163
Mailing Address - Fax:
Practice Address - Street 1:34700 11TH PL S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6715
Practice Address - Country:US
Practice Address - Phone:253-946-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60666717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist