Healthcare Provider Details

I. General information

NPI: 1679968143
Provider Name (Legal Business Name): MEISAM FAEGHI NEJAD D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 S 324TH PL
FEDERAL WAY WA
98003-8505
US

IV. Provider business mailing address

901 8TH AVE APT 202
SEATTLE WA
98104-4270
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-1225
  • Fax:
Mailing address:
  • Phone: 909-991-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE 60482234
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: