Provider Demographics
NPI:1306399381
Name:SHANE T NESS DDS PLLC
Entity Type:Organization
Organization Name:SHANE T NESS DDS PLLC
Other - Org Name:NESS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-898-8699
Mailing Address - Street 1:23515 NE NOVELTY HILL RD STE 209
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-5505
Mailing Address - Country:US
Mailing Address - Phone:425-898-8699
Mailing Address - Fax:425-898-1310
Practice Address - Street 1:23515 NE NOVELTY HILL RD STE 209
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5505
Practice Address - Country:US
Practice Address - Phone:425-898-8699
Practice Address - Fax:425-898-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10561261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA10561OtherSTATE LICENSE