# BAJWA WONG PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eastside Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407476484
- **Authorized official:** SOFIA SEGURA (CREDENTIALING MANAGER)
- **Authorized official phone:** (509) 901-2239

## Contact information

- **Practice address:** 640 NW GILMAN BLVD STE 100, ISSAQUAH, WA 98027-2476
- **Practice address phone:** (425) 507-2888
- **Practice address fax:** (425) 507-2887
- **Mailing address:** 640 NW GILMAN BLVD STE 100, ISSAQUAH, WA 98027-2476
- **Mailing address phone:** (425) 507-2888
- **Mailing address fax:** (425) 507-2887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/20/2020
- **Last updated:** 04/20/2020