Provider Demographics
NPI:1205727815
Name:MOR, ANSHUL (DMD)
Entity type:Individual
Prefix:
First Name:ANSHUL
Middle Name:
Last Name:MOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27207 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7653
Mailing Address - Country:US
Mailing Address - Phone:253-951-6813
Mailing Address - Fax:
Practice Address - Street 1:10725 SE 256TH ST STE 1
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-8285
Practice Address - Country:US
Practice Address - Phone:206-429-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.70015222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist