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ROOZBEH KHOSRAVI DMD PHD LLC NPI 1962913509


NPI Information

NPI: 1962913509
Provider Name: ROOZBEH KHOSRAVI DMD PHD LLC

Doing Business As: PORTH

Classification: Dentist - 1223X0400X
Entity Type: Organization

Specialization: Orthodontics and Dentofacial Orthopedics

Address:
22620 SE 4TH ST STE 210
SAMMAMISH, WA
ZIP 98074
Phone: (425) 526-2060
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ROOZBEH KHOSRAVI DMD PHD LLC is an orthodontics and dentofacial orthopedics dentist in Sammamish, WA. The provider is that area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. ROOZBEH KHOSRAVI DMD PHD LLC NPI is 1962913509. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Porth.

The provider's business location address is:

22620 SE 4TH ST STE 210
SAMMAMISH, WA
ZIP 98074-375
Phone: (425) 526-2060

The provider's authorized official is Roozbeh Khosravi .
The authorized official title is Orthodontist and has the following contact phone number (617) 466-9090.

The enumeration date for this NPI number is 10/23/2017 and was last updated on 10/23/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223X0400XDentistOrthodontics and Dentofacial OrthopedicsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11629433891MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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