Provider Demographics
NPI:1508952268
Name:TABARAIE, ELHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:TABARAIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:TABARAIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1855 156TH AVE NE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4386
Mailing Address - Country:US
Mailing Address - Phone:425-747-2908
Mailing Address - Fax:425-747-0782
Practice Address - Street 1:1855 156TH AVE NE
Practice Address - Street 2:SUITE 212
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4386
Practice Address - Country:US
Practice Address - Phone:425-747-2908
Practice Address - Fax:425-747-0782
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA90481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice