Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DE60233845 | WA |
N | 1223E0200X | Endodontist | DS038054 | PA |
NPI | 1134434475 |
---|---|
Provider Name | Dr. Nima Dejbod |
First Address | Issaquah, WA 98027-2445 |
Second Address | Issaquah, WA 98027-2445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2010 |
Last Update Date | 15/06/2017 |