Provider Demographics
NPI:1124445523
Name:ZAREI, OMID (DENTURIST)
Entity type:Individual
Prefix:
First Name:OMID
Middle Name:
Last Name:ZAREI
Suffix:
Gender:M
Credentials:DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15003 SE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-2568
Mailing Address - Country:US
Mailing Address - Phone:206-617-0588
Mailing Address - Fax:
Practice Address - Street 1:15003 SE 46TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-2568
Practice Address - Country:US
Practice Address - Phone:206-617-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60271513122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist