Provider Demographics
NPI:1780968065
Name:BAKHTAWAR, SYEDA (DMD)
Entity type:Individual
Prefix:DR
First Name:SYEDA
Middle Name:
Last Name:BAKHTAWAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 - 106TH AVE NE
Mailing Address - Street 2:#410
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-2005
Mailing Address - Fax:425-454-1360
Practice Address - Street 1:188 - 106TH AVE NE
Practice Address - Street 2:#410
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-2005
Practice Address - Fax:425-454-1360
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602385961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice