Provider Demographics
NPI:1235343526
Name:FACIAL SURGERY CENTER OF SEATTLE
Entity Type:Organization
Organization Name:FACIAL SURGERY CENTER OF SEATTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DYANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIDDAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-624-0852
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE 1454
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1720
Mailing Address - Country:US
Mailing Address - Phone:206-624-0852
Mailing Address - Fax:206-622-2084
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 1454
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-624-0852
Practice Address - Fax:206-622-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA92461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty