Organization
ROOZBEH KHOSRAVI DMD PHD LLC
Active
Organization
ROOZBEH KHOSRAVI DMD PHD LLC
Active
Other names
Porth
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROOZBEH KHOSRAVI DMD PHD MSD (ORTHODONTIST)
(617) 466-9090
Entity
Organization
Contact information
Practice address
22620 SE 4TH ST STE 210, SAMMAMISH, WA 98074-7375
(425) 526-2060
Mailing address
22620 SE 4TH ST STE 210, SAMMAMISH, WA 98074-7375
(425) 526-2060
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629433891
—
WA
Enumeration date
10/23/2017
Last updated
10/23/2020
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