Provider Demographics
NPI:1770862377
Name:SOHRABI ANARAKI, KEYVAN (DDS, MMSC, MSD)
Entity Type:Individual
Prefix:DR
First Name:KEYVAN
Middle Name:
Last Name:SOHRABI ANARAKI
Suffix:
Gender:M
Credentials:DDS, MMSC, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 STATE ROUTE 9 NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7992
Mailing Address - Country:US
Mailing Address - Phone:425-249-4129
Mailing Address - Fax:
Practice Address - Street 1:709 STATE ROUTE 9 NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258
Practice Address - Country:US
Practice Address - Phone:425-249-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603345911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics