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General NPI Number Information
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NPI Number | 1467594465
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Entity Type | Organization
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Legal Business Name | STATE OF WA, DEPT. OF SOCIAL AND HEALTH SVS.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15230 15TH AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-7130
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Country | US
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Telephone | 206-361-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 LAKE WASHINGTON BLVD SE #211
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City | BELLEVUE
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State | WA
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Zip | 98006-1105
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Country | US
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Telephone | 425-221-0228
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Fax |
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | ASHA SINGH
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Credential | M.D.
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Telephone | 206-361-3033
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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 | DE00009387
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License Number State | WA
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