Provider Demographics
NPI:1326519174
Name:IMAHN MOIN, DDS, PLLC
Entity Type:Organization
Organization Name:IMAHN MOIN, DDS, PLLC
Other - Org Name:WALLINGFORD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAHN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:MOIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-633-4007
Mailing Address - Street 1:3941 WALLINGFORD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8247
Mailing Address - Country:US
Mailing Address - Phone:066-334-0072
Mailing Address - Fax:
Practice Address - Street 1:3941 WALLINGFORD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8247
Practice Address - Country:US
Practice Address - Phone:206-633-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental