=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851485338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOODSIDE & WOODSIDE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 42ND AVE. E.
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-323-6555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 42ND AVE. E.
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. COLLINS WOODSIDE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 206-323-6555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 00008202
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------