Provider Demographics
NPI:1518241447
Name:KARBAKHSCH PERIODONTICS & IMPLANTS, PLLC - NORTH
Entity Type:Organization
Organization Name:KARBAKHSCH PERIODONTICS & IMPLANTS, PLLC - NORTH
Other - Org Name:MK PERIODONTICS & IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINOU
Authorized Official - Middle Name:
Authorized Official - Last Name:KARBAKHSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:425-820-2414
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:SUITE F-240
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3027
Mailing Address - Country:US
Mailing Address - Phone:425-820-2414
Mailing Address - Fax:425-814-1757
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE F-240
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-820-2414
Practice Address - Fax:425-814-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA85791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty