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General NPI Number Information
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NPI Number | 1811303167
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Entity Type | Individual
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Provider Name | YONATAN AHDUT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 1901 S UNION AVE SUITE B-3008
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City | TACOMA
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State | WA
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Zip | 98405-1702
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Country | US
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Telephone | 253-572-9777
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Fax | 253-627-6766
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Provider Business Mailing Address
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Address Line | 6517 25TH AVE NE APT. B
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City | SEATTLE
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State | WA
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Zip | 98115-7160
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Country | US
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Telephone | 253-426-5821
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Fax | 253-627-6766
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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 | DE60479557
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License Number State | WA
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