Healthcare Provider Details

I. General information

NPI: 1235343526
Provider Name (Legal Business Name): FACIAL SURGERY CENTER OF SEATTLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY SUITE 1454
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

509 OLIVE WAY SUITE 1454
SEATTLE WA
98101-1720
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-0852
  • Fax: 206-622-2084
Mailing address:
  • Phone: 206-624-0852
  • Fax: 206-622-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9246
License Number StateWA

VIII. Authorized Official

Name: DYANNE K. MIDDAUGH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 206-624-0852