Healthcare Provider Details

I. General information

NPI: 1932726049
Provider Name (Legal Business Name): USAMA AL SAEDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 NW 85TH ST APT 110
SEATTLE WA
98117-4298
US

IV. Provider business mailing address

1421 NW 85TH ST # 111
SEATTLE WA
98117-4298
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-0111
  • Fax:
Mailing address:
  • Phone: 206-789-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberD160753339
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: