Provider Demographics
NPI:1124032321
Name:VAN DER SLUYS, RICHARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:VAN DER SLUYS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22350 NE MARKETPLACE DR
Mailing Address - Street 2:#102
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2039
Mailing Address - Country:US
Mailing Address - Phone:425-836-8555
Mailing Address - Fax:425-836-8556
Practice Address - Street 1:22350 NE MARKETPLACE DR
Practice Address - Street 2:#102
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2039
Practice Address - Country:US
Practice Address - Phone:425-836-8555
Practice Address - Fax:425-836-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000083611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice