Provider Demographics
NPI:1730511213
Name:MIRSEPASI AND ASSOCIATES, INC
Entity type:Organization
Organization Name:MIRSEPASI AND ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRSEPASI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:425-270-3926
Mailing Address - Street 1:85 NW ALDER PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3201
Mailing Address - Country:US
Mailing Address - Phone:425-270-3926
Mailing Address - Fax:425-270-3927
Practice Address - Street 1:85 NW ALDER PL
Practice Address - Street 2:SUITE B
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3201
Practice Address - Country:US
Practice Address - Phone:425-270-3926
Practice Address - Fax:425-270-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty