Provider Demographics
NPI:1396254660
Name:CHAWAN, SEEMALAXMI (AEGD)
Entity type:Individual
Prefix:
First Name:SEEMALAXMI
Middle Name:
Last Name:CHAWAN
Suffix:
Gender:F
Credentials:AEGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15566 NE 22ND PL UNIT 553
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3878
Mailing Address - Country:US
Mailing Address - Phone:310-948-6273
Mailing Address - Fax:
Practice Address - Street 1:164 SW CAMPUS DR STE 101
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-7926
Practice Address - Country:US
Practice Address - Phone:235-432-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605535321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice