Provider Demographics
NPI:1992367700
Name:HEMMAT, PAYAM (DDS)
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:HEMMAT
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 1:7435 CORLISS AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4932
Mailing Address - Country:US
Mailing Address - Phone:956-453-5873
Mailing Address - Fax:
Practice Address - Street 1:19620 HIGHWAY 99 STE 106
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5565
Practice Address - Country:US
Practice Address - Phone:425-670-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353461223G0001X
WA61085734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice