Provider Demographics
NPI:1114450517
Name:AFFORDABLE DENTAL GROUP INC
Entity Type:Organization
Organization Name:AFFORDABLE DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:THANHHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAREDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-224-6445
Mailing Address - Street 1:4217 64TH AVE E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2337
Mailing Address - Country:US
Mailing Address - Phone:360-224-6445
Mailing Address - Fax:
Practice Address - Street 1:411 STRANDER BLVD
Practice Address - Street 2:STE 204
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2935
Practice Address - Country:US
Practice Address - Phone:360-224-6445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty