Individual
DR. ERIC DEROVANESSIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
15710 NE 24TH ST, SUITE B, BELLEVUE, WA 98008-2444
(425) 644-6802
(425) 644-1426
Mailing address
15710 NE 24TH ST, SUITE B, BELLEVUE, WA 98008-2444
(425) 644-6802
(425) 644-1426
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
39144
CA
122300000X
Dentist
Primary
7600
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5034913
—
WA
Enumeration date
06/07/2013
Last updated
06/07/2013
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