Provider Demographics
NPI:1225445539
Name:IMPLANT & PERIODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:IMPLANT & PERIODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAIBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-453-1010
Mailing Address - Street 1:1418 112TH AVE NE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-453-1010
Mailing Address - Fax:425-637-8704
Practice Address - Street 1:1418 112TH AVE NE SUITE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-453-1010
Practice Address - Fax:425-637-8704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPLANT & PERIODONTIC SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty