Provider Demographics
NPI:1346471687
Name:BRAD A LARREAU DDS PS
Entity Type:Organization
Organization Name:BRAD A LARREAU DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-931-4410
Mailing Address - Street 1:3210 SMOKEY POINT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-7805
Mailing Address - Country:US
Mailing Address - Phone:360-653-5577
Mailing Address - Fax:360-659-1125
Practice Address - Street 1:3210 SMOKEY POINT DR STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7805
Practice Address - Country:US
Practice Address - Phone:360-653-5577
Practice Address - Fax:360-659-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6000746151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty