MEDICARE: DR. JOHN T. DYKSTRA D.D.S., P.L.L.C

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	4487	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477661999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN T. DYKSTRA D.D.S., P.L.L.C

Provider Business Mailing Address
First Line	:	520 N OLYMPIC AVE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1247
Country	:	US
Telephone Number	:	360-435-4043
Fax Number	:	360-435-2344

Provider Business Practice Location Address
First Line	:	520 N OLYMPIC AVE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1247
Country	:	US
Telephone Number	:	360-435-4043
Fax Number	:	360-435-2344

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	12/13/2016

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