Provider Demographics
NPI:1205130614
Name:PURVA MERCHANT PS
Entity type:Organization
Organization Name:PURVA MERCHANT PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PURVA
Authorized Official - Middle Name:SUHAS
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MSD
Authorized Official - Phone:425-246-4658
Mailing Address - Street 1:915 BELMONT AVE E
Mailing Address - Street 2:WA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4416
Mailing Address - Country:US
Mailing Address - Phone:425-246-4658
Mailing Address - Fax:
Practice Address - Street 1:2223 QUEEN ANNE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2313
Practice Address - Country:US
Practice Address - Phone:425-780-5439
Practice Address - Fax:206-432-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010876261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental