Provider Demographics
NPI:1508181082
Name:ROUHFAR DMD PS
Entity Type:Organization
Organization Name:ROUHFAR DMD PS
Other - Org Name:ROUHFAR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUHFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-558-9998
Mailing Address - Street 1:15446 BEL RED ROAD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5505
Mailing Address - Country:US
Mailing Address - Phone:425-558-9998
Mailing Address - Fax:425-558-9910
Practice Address - Street 1:15446 BEL RED RD
Practice Address - Street 2:SUITE #400
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5501
Practice Address - Country:US
Practice Address - Phone:425-558-9998
Practice Address - Fax:425-558-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA100651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty