MEDICARE: DR. ALBERTA ESI QUAIDOO D.D.S

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	1223G0001X	General Practice Dentistry	6386	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6386	OTHER	WA	WA. STATE LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	06936	OTHER	WA	WDS PROVIDER #

General Provider Information

NPI Number	:	1396950879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERTA ESI QUAIDOO D.D.S

Provider Business Mailing Address
First Line	:	509 OLIVE WAY STE 1033
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1724
Country	:	US
Telephone Number	:	800-979-4189
Fax Number	:	425-278-7094

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY STE 1033
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1724
Country	:	US
Telephone Number	:	800-979-4189
Fax Number	:	425-278-7094

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	02/04/2013

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