Healthcare Provider Details

I. General information

NPI: 1588911127
Provider Name (Legal Business Name): JOHAN KAREL APS DDS, MSC , MSC, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 NE 74TH ST THE CENTER FOR PEDIATRIC DENTISTRY, MAGNUSON PARK
SEATTLE WA
98115-8158
US

IV. Provider business mailing address

6222 NE 74TH STREET THE CENTER FOR PEDIATRIC DENTISTRY
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-5800
  • Fax:
Mailing address:
  • Phone: 206-543-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDF60285860
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDF60285860
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: