Provider Demographics
NPI:1316190234
Name:ED CARDIFF D.D.S., P.S.
Entity Type:Organization
Organization Name:ED CARDIFF D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-542-5590
Mailing Address - Street 1:10014 238TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5735
Mailing Address - Country:US
Mailing Address - Phone:206-542-5590
Mailing Address - Fax:
Practice Address - Street 1:10014 238TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5735
Practice Address - Country:US
Practice Address - Phone:206-542-5590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000036701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5025374Medicaid