Healthcare Provider Details

I. General information

NPI: 1700283546
Provider Name (Legal Business Name): DENTAL MED ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7513 SE 27TH ST STE B
MERCER ISLAND WA
98040-2845
US

IV. Provider business mailing address

3040 78TH AVE SE UNIT 1758
MERCER ISLAND WA
98040-3769
US

V. Phone/Fax

Practice location:
  • Phone: 425-757-2736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 00007494
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA PLOTKIN SAEPOFF
Title or Position: DENTIST
Credential: DDS
Phone: 206-799-1102