Provider Demographics
NPI:1023412871
Name:MEHRAN VAREDI DDS, PLLC
Entity type:Organization
Organization Name:MEHRAN VAREDI DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAREDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-587-4669
Mailing Address - Street 1:4217 64TH AVE E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2337
Mailing Address - Country:US
Mailing Address - Phone:205-587-4669
Mailing Address - Fax:
Practice Address - Street 1:14027 AMBAUM BLVD SW
Practice Address - Street 2:UNIT A2
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1207
Practice Address - Country:US
Practice Address - Phone:205-587-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60473974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649671934OtherPERSONAL