Individual
SHIV PRUTHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MPH
Contact information
Practice address
1732 BROADWAY UNIT 101, SEATTLE, WA 98122-2621
(206) 785-1327
Mailing address
2651 BRAEBURN LN SW, ROCHESTER, MN 55902-3495
(507) 993-8183
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D011502
AZ
1223G0001X
General Practice Dentistry
Primary
DE61478519
WA
Other
Enumeration date
07/10/2022
Last updated
10/16/2023
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