Provider Demographics
NPI:1326311705
Name:ADVANCED DENTAL IMPLANTS
Entity Type:Organization
Organization Name:ADVANCED DENTAL IMPLANTS
Other - Org Name:RESTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PERIODONTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPOPORT
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MSD
Authorized Official - Phone:206-575-1086
Mailing Address - Street 1:411 STRANDER BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 STRANDER BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2935
Practice Address - Country:US
Practice Address - Phone:800-469-9879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000085081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty