Healthcare Provider Details

I. General information

NPI: 1619320173
Provider Name (Legal Business Name): BARTON L SOPER
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

14575 BEL RED RD SUITE 200
BELLEVUE WA
98007-3908
US

IV. Provider business mailing address

14575 BEL RED RD SUITE 200
BELLEVUE WA
98007-3908
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-9494
  • Fax: 425-747-9428
Mailing address:
  • Phone: 425-747-9494
  • Fax: 425-747-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7807
License Number StateWA

VIII. Authorized Official

Name: BARTON L SOPER
Title or Position: OWNER
Credential: DDS MS PLLC
Phone: 425-747-9494