MEDICARE: PETER TOM POPEK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE61433011	WA

General Provider Information

NPI Number	:	1720723596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER TOM POPEK DDS

Provider Business Mailing Address
First Line	:	2045 WESTLAKE AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-2605
Country	:	US
Telephone Number	:	206-207-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 WESTLAKE AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-2605
Country	:	US
Telephone Number	:	206-207-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	06/13/2023

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Directions to “ PETER TOM POPEK DDS” Practice Location

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