Provider Demographics
NPI:1225134497
Name:DORSEY, DANIEL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:DORSEY
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1300 ESTHER ST
Mailing Address - Street 2:#100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2889
Mailing Address - Country:US
Mailing Address - Phone:360-695-9248
Mailing Address - Fax:360-695-9249
Practice Address - Street 1:300 SE 120TH AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4090
Practice Address - Country:US
Practice Address - Phone:360-260-3290
Practice Address - Fax:360-260-3291
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA54101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02555Medicare UPIN