Provider Demographics
NPI:1184636896
Name:FORD, JOHN PATRICK JR (DDS PS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:FORD
Suffix:JR
Gender:M
Credentials:DDS PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18218 52ND AVE W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037
Mailing Address - Country:US
Mailing Address - Phone:425-775-2733
Mailing Address - Fax:425-771-0612
Practice Address - Street 1:18218 52ND AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037
Practice Address - Country:US
Practice Address - Phone:425-775-2733
Practice Address - Fax:425-771-0612
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5315809Medicaid
WA5315809Medicaid