Provider Demographics
NPI:1548375124
Name:ASHOKA SUBEDAR DMD
Entity type:Organization
Organization Name:ASHOKA SUBEDAR DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBEDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-647-4262
Mailing Address - Street 1:2980 SQUALICUM PKWY
Mailing Address - Street 2:STE 302
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-647-4262
Mailing Address - Fax:360-527-0110
Practice Address - Street 1:2980 SQUALICUM PKWY
Practice Address - Street 2:STE 302
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-647-4262
Practice Address - Fax:360-527-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U73701Medicare UPIN