Provider Demographics
NPI:1003099466
Name:DEREK R DAMON DDS PS
Entity Type:Organization
Organization Name:DEREK R DAMON DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-676-6060
Mailing Address - Street 1:1220 22ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2582
Mailing Address - Country:US
Mailing Address - Phone:360-293-2888
Mailing Address - Fax:360-299-0405
Practice Address - Street 1:1220 22ND ST STE A
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2582
Practice Address - Country:US
Practice Address - Phone:360-293-2888
Practice Address - Fax:360-299-0405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEREK R DAMON DDS PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-08
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE79661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty