Provider Demographics
NPI:1083884191
Name:PATRICK ROONEY D.D.S. P.S.
Entity Type:Organization
Organization Name:PATRICK ROONEY D.D.S. P.S.
Other - Org Name:BLAINE HARBOR DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PS
Authorized Official - Phone:360-332-2400
Mailing Address - Street 1:215 MARINE DR # 1
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4036
Mailing Address - Country:US
Mailing Address - Phone:360-332-2400
Mailing Address - Fax:360-332-7161
Practice Address - Street 1:215 MARINE DR # 1
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4036
Practice Address - Country:US
Practice Address - Phone:360-332-2400
Practice Address - Fax:360-332-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028790Medicaid