Provider Demographics
NPI:1134685589
Name:WAYNE E. SVOBODA DDS PC
Entity Type:Organization
Organization Name:WAYNE E. SVOBODA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ETNYRE
Authorized Official - Last Name:SVOBODA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-219-1231
Mailing Address - Street 1:32105 1ST AVE S STE B3
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5719
Mailing Address - Country:US
Mailing Address - Phone:253-219-1231
Mailing Address - Fax:253-838-2560
Practice Address - Street 1:32105 1ST AVE S STE B3
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5719
Practice Address - Country:US
Practice Address - Phone:253-219-1231
Practice Address - Fax:253-838-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental