Provider Demographics
NPI:1093393258
Name:PANAHPOUR ESLAMI, NOUSHA (DDS)
Entity Type:Individual
Prefix:
First Name:NOUSHA
Middle Name:
Last Name:PANAHPOUR ESLAMI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1292
Mailing Address - Country:US
Mailing Address - Phone:360-435-3661
Mailing Address - Fax:
Practice Address - Street 1:302 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1292
Practice Address - Country:US
Practice Address - Phone:360-435-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR61164812122300000X
390200000X
WADE61268684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program