1457449712 NPI number — DR. OWEN E PACKARD DDS

Table of content: DR. OWEN E PACKARD DDS (NPI 1457449712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457449712 NPI number — DR. OWEN E PACKARD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACKARD
Provider First Name:
OWEN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1457449712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 S 40TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908-3963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-577-8277
Provider Business Mailing Address Fax Number:
509-573-4858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S 40TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-3963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-577-8277
Provider Business Practice Location Address Fax Number:
509-573-4858
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7355 , 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: 5018668 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103737 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 529962 . This is a "DELTA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 92560941 . This is a "TPIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7355 . This is a "WA STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8923147 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com