Provider Demographics
NPI:1871745588
Name:BANSAL, SHRADHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHRADHA
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WINDSOR DR SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-3422
Mailing Address - Country:US
Mailing Address - Phone:425-830-4773
Mailing Address - Fax:
Practice Address - Street 1:85 NW ALDER PL STE B
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3201
Practice Address - Country:US
Practice Address - Phone:425-657-0609
Practice Address - Fax:866-528-2025
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry