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General NPI Number Information
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NPI Number | 1053683862
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Entity Type | Organization
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Legal Business Name | ALLAN D. MINAHAN, DDS, PLLC
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 17171 BOTHELL WAY NE
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City | LAKE FOREST PARK
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State | WA
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Zip | 98155-4204
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Country | US
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Telephone | 206-365-5454
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Fax |
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Provider Business Mailing Address
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Address Line | 16315 48TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-4809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ALLAN DAVID MINAHAN
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Credential | DDS
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Telephone | 206-550-3718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE 60106555
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License Number State | WA
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