Provider Demographics
NPI:1346928041
Name:NAJARIANTOUSI, MAHBOUBEH
Entity Type:Individual
Prefix:
First Name:MAHBOUBEH
Middle Name:
Last Name:NAJARIANTOUSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SE 36TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1657
Mailing Address - Country:US
Mailing Address - Phone:206-767-4851
Mailing Address - Fax:
Practice Address - Street 1:14100 SE 36TH ST STE 125
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1657
Practice Address - Country:US
Practice Address - Phone:206-767-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614444461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice