Provider Demographics
NPI:1871046151
Name:VIKRAM LIKHARI BDS, MS
Entity Type:Organization
Organization Name:VIKRAM LIKHARI BDS, MS
Other - Org Name:EASTSIDE PERIODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:425-643-5412
Mailing Address - Street 1:13635 BEL RED RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4555
Mailing Address - Country:US
Mailing Address - Phone:425-643-5412
Mailing Address - Fax:
Practice Address - Street 1:13635 BEL RED RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4555
Practice Address - Country:US
Practice Address - Phone:425-643-5412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIKHARI PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010984261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental