Provider Demographics
NPI:1083761605
Name:HAWORTH, TODD D (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:HAWORTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 E LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7952
Mailing Address - Country:US
Mailing Address - Phone:360-457-5152
Mailing Address - Fax:360-457-6673
Practice Address - Street 1:422 E LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7952
Practice Address - Country:US
Practice Address - Phone:360-457-5152
Practice Address - Fax:360-457-6673
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA62111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice