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General NPI Number Information
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NPI Number | 1174979918
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Entity Type | Organization
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Legal Business Name | DELTA DENTAL OF WASHINGTON
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 9706 4TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98115-2157
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Country | US
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Telephone | 206-528-2351
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Fax |
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Provider Business Mailing Address
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Address Line | 9706 4TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98115-2157
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Country | US
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Telephone | 206-528-2351
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Fax |
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Authorized Official
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Title or Position | COO & CFO
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Name | MR. BRADLEY A BERG
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Credential |
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Telephone | 206-528-2340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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