Provider Demographics
NPI:1326070079
Name:EVERETT, III, ALBERT F (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:F
Last Name:EVERETT, III
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:#F-200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3027
Mailing Address - Country:US
Mailing Address - Phone:425-821-9111
Mailing Address - Fax:425-820-2950
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:#F-200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-821-9111
Practice Address - Fax:425-820-2950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA49221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA569122OtherUNITED CONCORDIA ID#
WA5513908Medicaid