MEDICARE: MAIRA SABEEH DMD

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	1223G0001X	General Practice Dentistry	DE61111061	WA

General Provider Information

NPI Number	:	1982200879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIRA SABEEH DMD

Provider Business Mailing Address
First Line	:	1900 STEVENS DR APT 323
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2163
Country	:	US
Telephone Number	:	617-717-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	6607 W CANAL DR STE B
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-5077
Country	:	US
Telephone Number	:	509-783-7070
Fax Number	:

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

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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