Healthcare Provider Details

I. General information

NPI: 1285849331
Provider Name (Legal Business Name): MARYAM AMINIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 ROOSEVELT WAY NE
SEATTLE WA
98105-4717
US

IV. Provider business mailing address

4341 ROOSEVELT WAY NE
SEATTLE WA
98105-4717
US

V. Phone/Fax

Practice location:
  • Phone: 206-633-2600
  • Fax: 206-633-2536
Mailing address:
  • Phone: 206-633-2600
  • Fax: 206-633-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE00006843
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: