Provider Demographics
NPI:1861909210
Name:NASSIM DDS, PS
Entity type:Organization
Organization Name:NASSIM DDS, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-229-7977
Mailing Address - Street 1:7030 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5917
Mailing Address - Country:US
Mailing Address - Phone:206-229-7977
Mailing Address - Fax:
Practice Address - Street 1:7030 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5917
Practice Address - Country:US
Practice Address - Phone:206-229-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty