Provider Demographics
NPI:1952886566
Name:KIRAN MISTRY, DDS, PC
Entity Type:Organization
Organization Name:KIRAN MISTRY, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-496-0682
Mailing Address - Street 1:18207 SE 20TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1800
Mailing Address - Country:US
Mailing Address - Phone:714-496-0682
Mailing Address - Fax:
Practice Address - Street 1:4414 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1154
Practice Address - Country:US
Practice Address - Phone:503-288-7481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty