Provider Demographics
NPI:1982045977
Name:FOROUTAN, NIMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:FOROUTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 OVERLAKE DR E
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-5326
Mailing Address - Country:US
Mailing Address - Phone:425-786-8879
Mailing Address - Fax:
Practice Address - Street 1:9 LAKE BELLEVUE DR STE 204
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2454
Practice Address - Country:US
Practice Address - Phone:425-454-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADNT.DE.60384118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist