1649634643 NPI number — STEVEN L PAIGE DDS & LEROY HORTON DDS COVINGTON - PLLC

Table of content: (NPI 1649634643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649634643 NPI number — STEVEN L PAIGE DDS & LEROY HORTON DDS COVINGTON - PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN L PAIGE DDS & LEROY HORTON DDS COVINGTON - PLLC
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:
AFFORDABLE DENTAL CARE
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:
1649634643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16720 SE 271ST ST
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-7342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-630-3500
Provider Business Mailing Address Fax Number:
253-630-3501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16720 SE 271ST ST
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-7342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-630-3500
Provider Business Practice Location Address Fax Number:
253-630-3501
Provider Enumeration Date:
04/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HORTON
Authorized Official First Name:
LEROY
Authorized Official Middle Name:
DIMITRIOS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-630-3500

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00011048 , 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