Provider Demographics
NPI:1366019820
Name:NAZEMAN, PANTEA (DDS)
Entity Type:Individual
Prefix:
First Name:PANTEA
Middle Name:
Last Name:NAZEMAN
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 1:10401 113TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5082
Mailing Address - Country:US
Mailing Address - Phone:408-966-5485
Mailing Address - Fax:
Practice Address - Street 1:555 S RENTON VILLAGE PL STE 610
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3287
Practice Address - Country:US
Practice Address - Phone:425-271-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611502811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics