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General NPI Number Information
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NPI Number | 1003099466
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Entity Type | Organization
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Legal Business Name | DEREK R DAMON DDS PS
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Dates
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Enumeration Date | 12/08/2007
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 1220 22ND ST STE A
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City | ANACORTES
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State | WA
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Zip | 98221-2582
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Country | US
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Telephone | 360-293-2888
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Fax | 360-299-0405
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Provider Business Mailing Address
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Address Line | 1220 22ND ST STE A
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City | ANACORTES
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State | WA
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Zip | 98221-2582
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Country | US
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Telephone | 360-293-2888
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Fax | 360-299-0405
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEREK RICHARD DAMON
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Credential | DDS
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Telephone | 360-676-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE7966
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License Number State | WA
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