Provider Demographics
NPI:1902032212
Name:BANDA, ABHISHAKE K (DMD, MD)
Entity Type:Individual
Prefix:
First Name:ABHISHAKE
Middle Name:K
Last Name:BANDA
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14420 NE BEL RED RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3930
Mailing Address - Country:US
Mailing Address - Phone:425-644-8000
Mailing Address - Fax:
Practice Address - Street 1:14420 NE BEL RED RD STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3930
Practice Address - Country:US
Practice Address - Phone:425-644-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA605612871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program