Healthcare Provider Details

I. General information

NPI: 1356743397
Provider Name (Legal Business Name): PASHA MOSTOFI MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S CARR RD STE 300
RENTON WA
98055-5840
US

IV. Provider business mailing address

601 S CARR RD STE 300
RENTON WA
98055-5840
US

V. Phone/Fax

Practice location:
  • Phone: 425-277-1844
  • Fax:
Mailing address:
  • Phone: 425-277-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number61318058
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD61308911
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: