1346492246 NPI number — ANTHONY DIRE, D.D.S.,P.S.

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 1346492246 NPI number — ANTHONY DIRE, D.D.S.,P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY DIRE, D.D.S.,P.S.
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:
1346492246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 STRANDER BLVD
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
TUKWILA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98188-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-575-1125
Provider Business Mailing Address Fax Number:
206-575-2825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 STRANDER BLVD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-575-1125
Provider Business Practice Location Address Fax Number:
206-575-2825
Provider Enumeration Date:
10/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STAHL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANGAGER
Authorized Official Telephone Number:
206-575-1125

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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