Individual provider Active NPI

Mitra Behforooz

  • General Practice Dentistry
  • Seattle, WA
National Provider Identifier
1922747922
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
61315296 Issued in WA
Practice address
620 1St Ave N
Seattle, WA 98109-4001
Phone
(206) 962-2835
NPI assigned
May 31, 2022
Last updated
May 31, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 61315296 WA Primary

Addresses

Primary practice location

620 1St Ave N
Seattle, WA 98109-4001

Mailing address

15551 NE Turing St Apt 501
Redmond, WA 98052-2488
Phone (765) 749-3557

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220920001673 WA Order and Referring Only - DentistPractitioner - Dentist 7618352105

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61315296WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Dental Corporation, PC General Practice CurrentSince Jun 5, 2022 Accepting new patients

Locations

620 1st Ave N
Seattle, WA 98109
Phone (206) 962-2835

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1922747922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15551 NE TURING ST APT 501",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980522488",
            "telephone_number": "765-749-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 1ST AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094001",
            "telephone_number": "206-962-2835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEHFOROOZ",
        "first_name": "MITRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "61315296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.