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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