Healthcare Provider Details

I. General information

NPI: 1780261719
Provider Name (Legal Business Name): MATTIAS DILLING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 SENECA ST
SEATTLE WA
98101-2742
US

IV. Provider business mailing address

925 SENECA ST
SEATTLE WA
98101-2742
US

V. Phone/Fax

Practice location:
  • Phone: 206-583-6079
  • Fax:
Mailing address:
  • Phone: 206-583-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number61465698
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: