MEDICARE: DR. DIANE DOPPEL DDS, MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	00006461	WA

General Provider Information

NPI Number	:	1366928319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE DOPPEL DDS, MSD

Provider Business Mailing Address
First Line	:	720 OLIVE WAY STE 920
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1840
Country	:	US
Telephone Number	:	206-682-1654
Fax Number	:	206-682-1190

Provider Business Practice Location Address
First Line	:	720 OLIVE WAY STE 920
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1840
Country	:	US
Telephone Number	:	206-682-1654
Fax Number	:	206-682-1190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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