Provider Demographics
NPI:1982305066
Name:JOSAN, RUPAM
Entity Type:Individual
Prefix:
First Name:RUPAM
Middle Name:
Last Name:JOSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16911 NE 78TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1554
Mailing Address - Country:US
Mailing Address - Phone:201-245-3561
Mailing Address - Fax:
Practice Address - Street 1:19005 SE 34TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1450
Practice Address - Country:US
Practice Address - Phone:360-726-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist