Provider Demographics
NPI:1952533226
Name:MIRSEPASI, HAMIDREZA (DDS, MS)
Entity Type:Individual
Prefix:
First Name:HAMIDREZA
Middle Name:
Last Name:MIRSEPASI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-542-2196
Mailing Address - Fax:206-542-4055
Practice Address - Street 1:1001 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5850
Practice Address - Country:US
Practice Address - Phone:972-231-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30750122300000X
WA11131223G0001X
WA60034321122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice