Healthcare Provider Details

I. General information

NPI: 1265543003
Provider Name (Legal Business Name): NIDAA HAMZA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16345 NE 87TH ST STE C2
REDMOND WA
98052-3503
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-8000
  • Fax:
Mailing address:
  • Phone: 425-277-1311
  • Fax: 252-771-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60240538
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number19550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: