Healthcare Provider Details

I. General information

NPI: 1861106668
Provider Name (Legal Business Name): BELLEVUE DENTIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14645 NE BEL RED RD STE 100
BELLEVUE WA
98007-3929
US

IV. Provider business mailing address

14645 NE BEL RED RD STE 100
BELLEVUE WA
98007-3929
US

V. Phone/Fax

Practice location:
  • Phone: 425-644-2205
  • Fax:
Mailing address:
  • Phone: 425-644-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SIAMAK NAJAFI-ABRANDABADI
Title or Position: PROSTHODONTIST
Credential: DDS
Phone: 425-644-2205