Healthcare Provider Details

I. General information

NPI: 1053764589
Provider Name (Legal Business Name): CHARLES R. ANDEREGG, JR., DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 BEL RED RD 202
BELLEVUE WA
98007-3900
US

IV. Provider business mailing address

14655 BEL RED RD 202
BELLEVUE WA
98007-3900
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-7007
  • Fax: 425-747-7342
Mailing address:
  • Phone: 425-747-7007
  • Fax: 425-747-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6833
License Number StateWA

VIII. Authorized Official

Name: DR. CHARLES ANDEREGG
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-747-7007