Provider Demographics
NPI:1114659976
Name:POURAHMARI, AIMAN (DE 61297295)
Entity Type:Individual
Prefix:
First Name:AIMAN
Middle Name:
Last Name:POURAHMARI
Suffix:
Gender:M
Credentials:DE 61297295
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14832 77TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-8438
Mailing Address - Country:US
Mailing Address - Phone:425-306-6558
Mailing Address - Fax:
Practice Address - Street 1:9623 32ND ST SE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-5779
Practice Address - Country:US
Practice Address - Phone:425-335-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE612972951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice