Provider Demographics
NPI:1629163464
Name:DARAB, POOYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:POOYA
Middle Name:
Last Name:DARAB
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 1:20410 27TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-3609
Mailing Address - Country:US
Mailing Address - Phone:425-774-3710
Mailing Address - Fax:425-774-3311
Practice Address - Street 1:21810 76TH AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7917
Practice Address - Country:US
Practice Address - Phone:425-774-3710
Practice Address - Fax:425-774-3311
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist