Basic Information
| Provider Information | |||||||||
| NPI: | 1285852822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAYYAH | ||||||||
| FirstName: | FARDAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15421 MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980129002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253168095 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15421 MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980129002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253168095 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE10200 | WA | Y | Dental Providers | Dentist | General Practice |
No ID Information.