Provider Demographics
NPI:1629750211
Name:VIMAWALA, ADITI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADITI
Middle Name:
Last Name:VIMAWALA
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 1:1825 148TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8206
Mailing Address - Country:US
Mailing Address - Phone:425-877-7190
Mailing Address - Fax:
Practice Address - Street 1:1001 AVENUE D STE 100
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2081
Practice Address - Country:US
Practice Address - Phone:360-568-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614671751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty