Provider Demographics
NPI:1346796141
Name:SUNEET S BATH D M D P S
Entity type:Organization
Organization Name:SUNEET S BATH D M D P S
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-493-1866
Mailing Address - Street 1:4538 MARTIN WAY E STE 103
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5387
Mailing Address - Country:US
Mailing Address - Phone:360-493-1866
Mailing Address - Fax:
Practice Address - Street 1:4538 MARTIN WAY E STE 103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5387
Practice Address - Country:US
Practice Address - Phone:360-493-1866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty