Healthcare Provider Details

I. General information

NPI: 1700054913
Provider Name (Legal Business Name): TRIPPEL & AUDIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 BEL RED RD STE 201
BELLEVUE WA
98007-3930
US

IV. Provider business mailing address

14420 BEL RED RD STE 201
BELLEVUE WA
98007-3930
US

V. Phone/Fax

Practice location:
  • Phone: 425-644-8000
  • Fax: 425-644-4888
Mailing address:
  • Phone: 425-644-8000
  • Fax: 425-644-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE00009124
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE0005495
License Number StateWA

VIII. Authorized Official

Name: DR. DOUGLAS TRIPPEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 425-644-8000