Healthcare Provider Details

I. General information

NPI: 1902352891
Provider Name (Legal Business Name): A. NIAZI, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 OLYMPIC DR NW SUITE #B-101
GIG HARBOR WA
98335-1767
US

IV. Provider business mailing address

5122 OLYMPIC DR NW SUITE #B-101
GIG HARBOR WA
98335-1767
US

V. Phone/Fax

Practice location:
  • Phone: 253-851-5544
  • Fax: 253-851-6561
Mailing address:
  • Phone: 253-851-5544
  • Fax: 253-851-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE00009574
License Number StateWA

VIII. Authorized Official

Name: DR. ARASH NIAZI SHARAKI
Title or Position: EXECUTER
Credential: DDS
Phone: 253-851-5544