Provider Demographics
NPI:1902777048
Name:DESHPANDE, MUKTAI ABHAY (BDS, MS)
Entity type:Individual
Prefix:
First Name:MUKTAI ABHAY
Middle Name:
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:BDS, MS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9742 NE 119TH WAY APT D314
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8948
Mailing Address - Country:US
Mailing Address - Phone:424-535-6321
Mailing Address - Fax:
Practice Address - Street 1:13501 100TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5209
Practice Address - Country:US
Practice Address - Phone:425-654-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.700308651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty