Provider Demographics
NPI:1396721593
Name:BAJWA, KAMAL HABIB (DDS)
Entity type:Individual
Prefix:MR
First Name:KAMAL
Middle Name:HABIB
Last Name:BAJWA
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 1:14242 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1443
Mailing Address - Country:US
Mailing Address - Phone:206-242-8080
Mailing Address - Fax:206-242-2339
Practice Address - Street 1:14242 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1443
Practice Address - Country:US
Practice Address - Phone:206-242-8080
Practice Address - Fax:206-242-2339
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist