Healthcare Provider Details

I. General information

NPI: 1467790790
Provider Name (Legal Business Name): DEAN GAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 N 105TH ST STE 101
SEATTLE WA
98133-8973
US

IV. Provider business mailing address

10413 BEARDSLEE BLVD
BOTHELL WA
98011-3463
US

V. Phone/Fax

Practice location:
  • Phone: 206-985-8482
  • Fax: 425-258-3701
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA60305852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: