Provider Demographics
NPI:1881901502
Name:PAWANDEEP
Entity type:Organization
Organization Name:PAWANDEEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAWANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-673-0223
Mailing Address - Street 1:431 E WARD ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4537
Mailing Address - Country:US
Mailing Address - Phone:206-673-0223
Mailing Address - Fax:
Practice Address - Street 1:431 E WARD ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4537
Practice Address - Country:US
Practice Address - Phone:206-673-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE- 601726101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty