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General NPI Number Information
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NPI Number | 1568694867
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Entity Type | Organization
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Legal Business Name | ALEXANDER SHOR OR EASTLAKE DENTAL
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 1500 FAIRVIEW AVENUE EAST STE. #300
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City | SEATTLE
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State | WA
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Zip | 98102
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Country | US
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Telephone | 206-325-7456
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Fax | 206-323-6273
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Provider Business Mailing Address
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Address Line | 1500 FAIRVIEW AVENUE EAST STE. #300
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City | SEATTLE
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State | WA
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Zip | 98102
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Country | US
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Telephone | 206-325-7456
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Fax | 206-323-6273
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ALEXANDER SHOR
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Credential | DMD, MSD
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Telephone | 206-325-7456
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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 | DE9117
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License Number State | WA
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