Healthcare Provider Details

I. General information

NPI: 1760530067
Provider Name (Legal Business Name): ALIREZA BESHARATI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 NE PARK DR STE C
ISSAQUAH WA
98029-2636
US

IV. Provider business mailing address

2520 NE PARK DR STE C
ISSAQUAH WA
98029-2636
US

V. Phone/Fax

Practice location:
  • Phone: 425-996-0457
  • Fax: 425-577-4132
Mailing address:
  • Phone: 425-577-4132
  • Fax: 425-996-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00010926
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: