Neda Modaresi, DDS, MS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE60903814 Issued in WA

Practice address

13114 120TH Ave NE
Kirkland, WA 98034-3014

Phone

(425) 296-7555

NPI assigned

Jan 14, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16800/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Modaresi PLLC

  • Pediatric Dentistry
  • Kirkland, WA
  • NPI 1952240764
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1437496239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10829 101ST PL NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980334431",
            "telephone_number": "949-394-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13114 120TH AVE NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343014",
            "telephone_number": "425-296-7555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3302 Gaston Ave",
            "address_2": "Pediatric Dentistry Department, Room 206",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752462013",
            "country_code": "US",
            "telephone_number": "214-828-8427",
            "fax_number": "214-874-4562",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "505 Cedar Ave",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "WA",
            "postal_code": "982704561",
            "country_code": "US",
            "telephone_number": "360-386-5197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODARESI",
        "first_name": "NEDA",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-14",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401414922",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60903814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mina Moazzeni, DDS
• Mock & Tran-Dilay Dentistry PLLC
• Erich Stephen Mock I, DDS
• Mod Skin and Body Clinic
• Modaresi PLLC
• Crystal Moddison
• Toni Moe, NBHWC, ACC
• Amina Mohamed
• Mohamed Odowa Mohamed
• Sucdi Mohamed

• Pediatric Dentistry in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.