Individual
DR. HOMAYOON FOTOVATJAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1314 UNION AVE NE, #8, RENTON, WA 98059-3959
(425) 227-9774
Mailing address
1314 UNION AVE NE, #8, RENTON, WA 98059-3959
(425) 227-9774
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00006854
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5019823
—
WA
Enumeration date
06/10/2009
Last updated
06/10/2009
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