Healthcare Provider Details

I. General information

NPI: 1659498301
Provider Name (Legal Business Name): UW DENTISTS - FACULTY ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST P.O. BOX 357131
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-8794
  • Fax: 206-616-9520
Mailing address:
  • Phone: 206-616-8794
  • Fax: 206-616-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT RUSSELL
Title or Position: MANAGER, PATIENT ACCOUNTS
Credential:
Phone: 206-616-8794