Provider Demographics
NPI:1053683862
Name:ALLAN D. MINAHAN, DDS, PLLC
Entity Type:Organization
Organization Name:ALLAN D. MINAHAN, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MINAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-550-3718
Mailing Address - Street 1:16315 48TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17171 BOTHELL WAY NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-4204
Practice Address - Country:US
Practice Address - Phone:206-365-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60106555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty