Provider Demographics
NPI:1760094668
Name:MOMI, PAVNEET (DDS)
Entity Type:Individual
Prefix:
First Name:PAVNEET
Middle Name:
Last Name:MOMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 185TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3813
Mailing Address - Country:US
Mailing Address - Phone:206-335-6770
Mailing Address - Fax:
Practice Address - Street 1:520 N OLYMPIC AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1247
Practice Address - Country:US
Practice Address - Phone:360-435-4043
Practice Address - Fax:360-435-2344
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61126699122300000X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program