1467436865 NPI number — JOSEPH ENGH DDS PS

Table of content: (NPI 1467436865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467436865 NPI number — JOSEPH ENGH DDS PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH ENGH DDS PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BELLEVUE DENTAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467436865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13131 120TH AVE NE
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-3037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-821-9833
Provider Business Mailing Address Fax Number:
425-821-9443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13131 120TH AVE NE
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-821-9833
Provider Business Practice Location Address Fax Number:
425-821-9443
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ENGH
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
GAR-KONG
Authorized Official Title or Position:
PRES SEC
Authorized Official Telephone Number:
425-821-9833

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE00008935 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5036421 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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