Provider Demographics
NPI:1336458074
Name:TODD R IRWIN DMD PLLC
Entity Type:Organization
Organization Name:TODD R IRWIN DMD PLLC
Other - Org Name:IRWIN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-457-0489
Mailing Address - Street 1:620 E. 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-457-0489
Mailing Address - Fax:360-452-3288
Practice Address - Street 1:620 E. 8TH STREET
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-457-0489
Practice Address - Fax:360-452-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7928261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental