Healthcare Provider Details

I. General information

NPI: 1790171312
Provider Name (Legal Business Name): DANIEL DUPUIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 NE 74TH ST
SEATTLE WA
98115-8158
US

IV. Provider business mailing address

6222 NE 74TH ST
SEATTLE WA
98115-8158
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE60570047
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: