Healthcare Provider Details

I. General information

NPI: 1144322751
Provider Name (Legal Business Name): ERICH BRENT NAUMANN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 120TH AVE NE
KIRKLAND WA
98034-6926
US

IV. Provider business mailing address

12330 120TH AVE NE
KIRKLAND WA
98034-6926
US

V. Phone/Fax

Practice location:
  • Phone: 425-821-7979
  • Fax:
Mailing address:
  • Phone: 206-383-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60068848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: