Healthcare Provider Details

I. General information

NPI: 1104147057
Provider Name (Legal Business Name): CHRISTINE M TWEEDY DDS MSD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 42ND AVE SW #24
SEATTLE WA
98116-4240
US

IV. Provider business mailing address

4520 42ND AVE SW #24
SEATTLE WA
98116-4240
US

V. Phone/Fax

Practice location:
  • Phone: 206-937-6481
  • Fax: 206-937-7043
Mailing address:
  • Phone: 206-937-6481
  • Fax: 206-937-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8359
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8359
License Number StateWA

VIII. Authorized Official

Name: DR. CHRISTINE M TWEEDY
Title or Position: OWNER
Credential: DDS MSD
Phone: 206-937-6481