Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60271513 | WA |
NPI | 1124445523 |
---|---|
Provider Name | Omid Zarei |
First Address | Bellevue, WA 98006-2568 |
Second Address | Bellevue, WA 98006-2568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 24/03/2014 |