Healthcare Provider Details

I. General information

NPI: 1114139599
Provider Name (Legal Business Name): ADAM PRISTERA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S 38TH CT STE 215
RENTON WA
98055-5777
US

IV. Provider business mailing address

350 S 38TH CT STE 215
RENTON WA
98055-5777
US

V. Phone/Fax

Practice location:
  • Phone: 425-430-1320
  • Fax: 425-430-1319
Mailing address:
  • Phone: 425-430-1320
  • Fax: 425-430-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number053094
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number009648
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE 60586504
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE 60586504
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: