Provider Demographics
NPI:1093924243
Name:HELDRIDGE, JOHN EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:HELDRIDGE
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 1:21701 76TH AVE W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7536
Mailing Address - Country:US
Mailing Address - Phone:425-744-1724
Mailing Address - Fax:
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:SUITE 202
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7536
Practice Address - Country:US
Practice Address - Phone:425-744-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000042861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5350608Medicaid
TO3005Medicare UPIN