Provider Demographics
NPI:1386892859
Name:MOAZAMI, ALALEH (DMD)
Entity type:Individual
Prefix:DR
First Name:ALALEH
Middle Name:
Last Name:MOAZAMI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9739
Mailing Address - Country:US
Mailing Address - Phone:425-636-8700
Mailing Address - Fax:425-896-8456
Practice Address - Street 1:7315 NE 141ST ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-9739
Practice Address - Country:US
Practice Address - Phone:425-636-8700
Practice Address - Fax:425-896-8456
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD91861223G0001X
WADE605118811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice