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General NPI Number Information
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NPI Number | 1801455381
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Entity Type | Organization
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Legal Business Name | ALI NASSIRI PLLC
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 6003 100TH ST SW
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City | LAKEWOOD
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State | WA
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Zip | 98499-2733
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Country | US
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Telephone | 425-466-0595
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Fax |
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Provider Business Mailing Address
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Address Line | 105 ERIE ST UNIT 1
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City | JERSEY CITY
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State | NJ
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Zip | 07302-2005
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Country | US
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Telephone | 425-466-0595
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALIREZA SADRE-NASSIRI
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Credential |
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Telephone | 425-466-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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