Provider Demographics
NPI:1942855135
Name:SINGH, MUKTA (DDS)
Entity Type:Individual
Prefix:
First Name:MUKTA
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18520 139TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8060
Mailing Address - Country:US
Mailing Address - Phone:201-918-0745
Mailing Address - Fax:
Practice Address - Street 1:25248 PACIFIC HWY S STE 105
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6530
Practice Address - Country:US
Practice Address - Phone:253-946-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60972334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist