Provider Demographics
NPI:1306392741
Name:QUEEN ANNE HILLTOP DENTAL
Entity Type:Organization
Organization Name:QUEEN ANNE HILLTOP DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BLOESER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PLLC
Authorized Official - Phone:206-658-3402
Mailing Address - Street 1:605 W MCGRAW ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2836
Mailing Address - Country:US
Mailing Address - Phone:206-284-6705
Mailing Address - Fax:
Practice Address - Street 1:605 W MCGRAW ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2836
Practice Address - Country:US
Practice Address - Phone:206-284-6705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty