Provider Demographics
NPI:1588243448
Name:NUSAYR, EYAD (DENTIST)
Entity type:Individual
Prefix:DR
First Name:EYAD
Middle Name:
Last Name:NUSAYR
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34709 9TH AVE S STE B300
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8715
Mailing Address - Country:US
Mailing Address - Phone:253-874-2583
Mailing Address - Fax:
Practice Address - Street 1:34709 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8722
Practice Address - Country:US
Practice Address - Phone:253-874-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61100565122300000X, 125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersDentistOral Medicine
No122300000XDental ProvidersDentist