Healthcare Provider Details

I. General information

NPI: 1548700495
Provider Name (Legal Business Name): ZEESHAWN MIRZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2017
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 BOREN AVE N
SEATTLE WA
98109-5502
US

IV. Provider business mailing address

4600 UNION BAY PL NE APT 611
SEATTLE WA
98105-5557
US

V. Phone/Fax

Practice location:
  • Phone: 206-274-1211
  • Fax:
Mailing address:
  • Phone: 732-513-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61566846
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: