Healthcare Provider Details

I. General information

NPI: 1427873355
Provider Name (Legal Business Name): ZAHRA SEYFALI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MARVIN RD NE STE 302
LACEY WA
98516-5710
US

IV. Provider business mailing address

8012 112TH STREET CT E STE 320
PUYALLUP WA
98373-7856
US

V. Phone/Fax

Practice location:
  • Phone: 360-459-8348
  • Fax:
Mailing address:
  • Phone: 253-848-2331
  • Fax: 253-840-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61593650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: