Provider Demographics
NPI:1013463736
Name:BELLEVUE EASTSIED ORTHODONTIC CENTER
Entity Type:Organization
Organization Name:BELLEVUE EASTSIED ORTHODONTIC CENTER
Other - Org Name:DR KEYVAN NAFICY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREATMENT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-881-8180
Mailing Address - Street 1:15700 BEL-RED ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008
Mailing Address - Country:US
Mailing Address - Phone:425-881-8180
Mailing Address - Fax:
Practice Address - Street 1:15700 BEL RED RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2231
Practice Address - Country:US
Practice Address - Phone:425-881-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000062221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty