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General NPI Number Information
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NPI Number | 1114139599
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Entity Type | Individual
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Provider Name | ADAM PRISTERA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 350 S 38TH CT STE 215
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City | RENTON
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State | WA
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Zip | 98055-5777
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Country | US
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Telephone | 425-430-1320
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Fax | 425-430-1319
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Provider Business Mailing Address
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Address Line | 350 S 38TH CT STE 215
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City | RENTON
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State | WA
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Zip | 98055-5777
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Country | US
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Telephone | 425-430-1320
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Fax | 425-430-1319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 053094
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License Number State | NY
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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 | 009648
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE 60586504
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DE 60586504
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License Number State | WA
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