1376613000 NPI number — R SCOTT PUHN 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 1376613000 NPI number — R SCOTT PUHN DDS PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R SCOTT PUHN 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:
Provider Other Organization Name Type Code:
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:
1376613000
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:
20730 BOND RD NE
Provider Second Line Business Mailing Address:
SUITE 202B
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-779-9090
Provider Business Mailing Address Fax Number:
360-779-9106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20730 BOND RD NE
Provider Second Line Business Practice Location Address:
SUITE 202B
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-779-9090
Provider Business Practice Location Address Fax Number:
360-779-9106
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PUHN
Authorized Official First Name:
RANDAL
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
360-779-9090

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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: 5517909 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 836940 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 94276 . This is a "DELTA DENTAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5027 . This is a "WDS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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