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General NPI Number Information
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NPI Number | 1104147057
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Entity Type | Organization
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Legal Business Name | CHRISTINE M TWEEDY DDS MSD PS
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 4520 42ND AVE SW #24
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City | SEATTLE
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State | WA
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Zip | 98116-4240
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Country | US
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Telephone | 206-937-6481
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Fax | 206-937-7043
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Provider Business Mailing Address
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Address Line | 4520 42ND AVE SW #24
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City | SEATTLE
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State | WA
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Zip | 98116-4240
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Country | US
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Telephone | 206-937-6481
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Fax | 206-937-7043
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTINE M TWEEDY
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Credential | DDS MSD
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Telephone | 206-937-6481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8359
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8359
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License Number State | WA
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