Healthcare Provider Details

I. General information

NPI: 1992876304
Provider Name (Legal Business Name): DEAN A DYSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12459 AMBAUM BLVD SOUTHWEST
BURIEN WA
98146-2660
US

IV. Provider business mailing address

12459 AMBAUM BLVD SOUTHWEST
BURIEN WA
98146-2660
US

V. Phone/Fax

Practice location:
  • Phone: 206-242-4961
  • Fax: 206-242-7644
Mailing address:
  • Phone: 206-242-4961
  • Fax: 206-242-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: