Basic Information
| Provider Information | |||||||||
| NPI: | 1821174517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HABIB | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6206 168TH SWST A | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980372749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257434674 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9710 STATE AVE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982702232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606531742 | ||||||||
| FaxNumber: | 3606532099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE00009369 | WA | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 0187740 | 01 | WA | STATE LABOR AND INDUSTRIE | OTHER | 3664HA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 5042783 | 05 | WA | MEDICAID |