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General NPI Number Information
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NPI Number | 1447696752
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Entity Type | Organization
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Legal Business Name | DERICK W. HAHN D.D.S., PLLC
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 1107 SW GRADY WAY SUITE 200
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City | RENTON
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State | WA
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Zip | 98057-5217
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Country | US
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Telephone | 425-226-9270
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Fax | 425-254-1129
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Provider Business Mailing Address
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Address Line | 720 S 38TH CT
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City | RENTON
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State | WA
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Zip | 98055-5894
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Country | US
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Telephone | 206-778-0592
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DERICK WAYNE HAHN
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Credential | D.D.S.
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Telephone | 206-778-0592
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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 | DE60035932
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License Number State | WA
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