Provider Demographics
NPI:1962184283
Name:MAHMOOD, NORISHA EHSAN
Entity type:Individual
Prefix:
First Name:NORISHA EHSAN
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1864
Mailing Address - Country:US
Mailing Address - Phone:509-795-3800
Mailing Address - Fax:
Practice Address - Street 1:15810 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1864
Practice Address - Country:US
Practice Address - Phone:509-795-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614644471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice