Provider Demographics
NPI:1790396893
Name:SAHLI, IM, GU PLLC
Entity Type:Organization
Organization Name:SAHLI, IM, GU PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOUTAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-291-9555
Mailing Address - Street 1:7100 FUN CENTER WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7100 FUN CENTER WAY STE 110
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5540
Practice Address - Country:US
Practice Address - Phone:425-291-9555
Practice Address - Fax:425-291-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery