1902973696 NPI number — KRISTAN K OVERBY DDS PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902973696 NPI number — KRISTAN K OVERBY DDS PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRISTAN K OVERBY 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:
DUPONT DENTAL
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:
1902973696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 STATION DR
Provider Second Line Business Mailing Address:
SUITE 221
Provider Business Mailing Address City Name:
DUPONT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98327-9777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-912-4443
Provider Business Mailing Address Fax Number:
253-912-4426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 STATION DR
Provider Second Line Business Practice Location Address:
SUITE 221
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98327-9777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-912-4443
Provider Business Practice Location Address Fax Number:
253-912-4426
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
SUEZANN
Authorized Official Middle Name:
LASSEN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
253-912-4443

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4388 , 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)





Copyright © 2007-2024 www.npivalidator.com