Provider Demographics
NPI:1073690160
Name:ATHERTON, DAVID REID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REID
Last Name:ATHERTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17130 AVONDALE WAY NE
Mailing Address - Street 2:SUITE # 118
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-869-1830
Mailing Address - Fax:425-869-9836
Practice Address - Street 1:17130 AVONDALE WAY NE
Practice Address - Street 2:SUITE # 118
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-869-1830
Practice Address - Fax:425-869-9836
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA056371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5007513OtherDSHS NUMBER