Healthcare Provider Details

I. General information

NPI: 1720604580
Provider Name (Legal Business Name): TREVOR TSUCHIKAWA DDS III PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 N 182ND ST STE 301
SHORELINE WA
98133-4400
US

IV. Provider business mailing address

721 N 182ND ST STE 301
SHORELINE WA
98133-4400
US

V. Phone/Fax

Practice location:
  • Phone: 206-542-4444
  • Fax: 206-542-5335
Mailing address:
  • Phone: 206-542-4444
  • Fax: 206-542-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TREVOR KENJ TSUCHIKAWA
Title or Position: OWNER
Credential:
Phone: 206-852-6836