Ebrahim Mirjalili, DDS is a medicare enrolled "Dentist - General Practice" provider in Buckley, Washington. His current practice location is
2120 Ryan Rd, Buckley, Washington. You can reach out to his office (for appointments etc.) via phone at
(360) 829-4920.
Ebrahim Mirjalili is licensed to practice in Washington (license number DE00007824) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1679650576.
Healthcare Provider's Profile
| Full Name | Ebrahim Mirjalili |
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| Gender | Male |
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| Speciality | Dentist - General Practice |
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| Location | 2120 Ryan Rd, Buckley, Washington |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1679650576
- Provider Enumeration Date: 11/01/2006
- Last Update Date: 07/30/2018
Medicare PECOS Information:
- PECOS PAC ID: 2668783341
- Enrollment ID: I20150622002099
Medical Identifiers
Medical identifiers for Ebrahim Mirjalili such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1679650576 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 1223G0001X | Dentist - General Practice | DE00007824 (Washington) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ebrahim Mirjalili is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Ebrahim Mirjalili, DDS Po Box 34703, Seattle, WA 98124-1703 Ph: (206) 764-0112 | Ebrahim Mirjalili, DDS 2120 Ryan Rd, Buckley, WA 98321 Ph: (360) 829-4920 |
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