Provider Demographics
NPI:1386806321
Name:SINGH, KHUSHWANT (DDS)
Entity type:Individual
Prefix:
First Name:KHUSHWANT
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33508 38TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98001-9567
Mailing Address - Country:US
Mailing Address - Phone:206-437-0188
Mailing Address - Fax:
Practice Address - Street 1:3280 SE LUND AVE
Practice Address - Street 2:SUITE #8
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2869
Practice Address - Country:US
Practice Address - Phone:360-874-6846
Practice Address - Fax:360-874-6853
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000102521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice