Provider Demographics
NPI:1396502985
Name:MODI, PALASH (DDS)
Entity type:Individual
Prefix:
First Name:PALASH
Middle Name:
Last Name:MODI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23013 27TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7272
Mailing Address - Country:US
Mailing Address - Phone:206-371-6916
Mailing Address - Fax:
Practice Address - Street 1:2402 S 1ST ST STE 108
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-1646
Practice Address - Country:US
Practice Address - Phone:509-574-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61399918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist