Provider Demographics
NPI:1972059178
Name:NAVABI SHIRAZI, REZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:NAVABI SHIRAZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 BURWELL ST APT 110
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1470
Mailing Address - Country:US
Mailing Address - Phone:305-600-7335
Mailing Address - Fax:
Practice Address - Street 1:11065 PACIFIC CREST PL NW STE B105
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6607
Practice Address - Country:US
Practice Address - Phone:360-261-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN221621223G0001X
WADE60792614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice