Basic Information
| Provider Information | |||||||||
| NPI: | 1972059178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAVABI SHIRAZI | ||||||||
| FirstName: | REZA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 BURWELL ST APT 110 | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983371470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056007335 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11065 PACIFIC CREST PL NW STE B105 | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983836607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602616154 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 11/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN22162 | FL | N | Dental Providers | Dentist | General Practice | 122300000X | DE60792614 | WA | Y | Dental Providers | Dentist |
No ID Information.