Provider Demographics
NPI:1083783807
Name:SAVAGE, DIANE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:S
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1514
Mailing Address - Country:US
Mailing Address - Phone:206-935-5050
Mailing Address - Fax:206-933-0918
Practice Address - Street 1:5647 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1514
Practice Address - Country:US
Practice Address - Phone:206-935-5050
Practice Address - Fax:206-933-0918
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA67491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice