Provider Demographics
NPI:1982200879
Name:SABEEH, MAIRA (DMD)
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:
Last Name:SABEEH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 STEVENS DR APT 323
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2163
Mailing Address - Country:US
Mailing Address - Phone:617-717-8442
Mailing Address - Fax:
Practice Address - Street 1:6607 W CANAL DR STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5077
Practice Address - Country:US
Practice Address - Phone:509-783-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611110611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice