Provider Demographics
NPI:1073061693
Name:PHILIP R. HOWARD DDS AND TARA M. SULLIVAN DDS, PLLC
Entity Type:Organization
Organization Name:PHILIP R. HOWARD DDS AND TARA M. SULLIVAN DDS, PLLC
Other - Org Name:PHILIP R. HOWARD DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-938-1777
Mailing Address - Street 1:4520 42ND AVE SW STE 23
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4240
Mailing Address - Country:US
Mailing Address - Phone:206-938-1777
Mailing Address - Fax:206-938-0740
Practice Address - Street 1:4520 42ND AVE SW STE 23
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4240
Practice Address - Country:US
Practice Address - Phone:206-938-1777
Practice Address - Fax:206-938-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010978305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization