Provider Demographics
NPI:1811732639
Name:MISHRA, TANMAY (DDS)
Entity type:Individual
Prefix:
First Name:TANMAY
Middle Name:
Last Name:MISHRA
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 1:76 CEDAR ST UNIT 313
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-4103
Mailing Address - Country:US
Mailing Address - Phone:612-757-2336
Mailing Address - Fax:
Practice Address - Street 1:6200 13TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2706
Practice Address - Country:US
Practice Address - Phone:206-461-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE615626321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice