Healthcare Provider Details

I. General information

NPI: 1013937507
Provider Name (Legal Business Name): DIANE M. DOPPEL, D.D.S., M.S.D., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE WAY STE 920
SEATTLE WA
98101-1840
US

IV. Provider business mailing address

720 OLIVE WAY STE 920
SEATTLE WA
98101-1840
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-1654
  • Fax: 206-682-1190
Mailing address:
  • Phone: 206-682-1654
  • Fax: 206-682-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE00006461
License Number StateWA

VIII. Authorized Official

Name: DR. DIANE M DOPPEL
Title or Position: PRESIDENT/ORTHODONTIST
Credential: D.D.S., M.S.D.
Phone: 206-682-1654