MEDICARE: NOUSHA PANAHPOUR ESLAMI DDS

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	122300000X	Dentist	DR61164812	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	122300000X	Dentist	DE61268684	WA

General Provider Information

NPI Number	:	1093393258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOUSHA PANAHPOUR ESLAMI DDS

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST BOX 356370
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-6370
Country	:	US
Telephone Number	:	206-543-6501
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST BOX 356370
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-1292
Country	:	US
Telephone Number	:	206-543-6501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	09/01/2025

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