MEDICARE: DR. MARYAM AMINIAN DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	6843	WA

General Provider Information

NPI Number	:	1023487717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MARYAM AMINIAN DDS PLLC

Provider Business Mailing Address
First Line	:	4341 ROOSEVELT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4717
Country	:	US
Telephone Number	:	206-633-2600
Fax Number	:	206-633-2536

Provider Business Practice Location Address
First Line	:	4341 ROOSEVELT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4717
Country	:	US
Telephone Number	:	206-633-2600
Fax Number	:	206-633-2536

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JACQUELINE MARIE WELCH
Credential	:
Telephone Number	:	206-633-2600

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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