Provider Demographics
NPI:1437400934
Name:MAINAYAR PLLC
Entity Type:Organization
Organization Name:MAINAYAR PLLC
Other - Org Name:EASTSIDE BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SAYED
Authorized Official - Last Name:MAINAYAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-753-0773
Mailing Address - Street 1:14605 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1669
Mailing Address - Country:US
Mailing Address - Phone:425-643-3912
Mailing Address - Fax:425-643-7988
Practice Address - Street 1:14605 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1669
Practice Address - Country:US
Practice Address - Phone:425-643-3912
Practice Address - Fax:425-643-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602989601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty