Provider Demographics
NPI:1407092760
Name:ATWOOD, MICHAEL ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 106TH AVE NE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4325
Mailing Address - Country:US
Mailing Address - Phone:425-453-2007
Mailing Address - Fax:425-637-0047
Practice Address - Street 1:1100 106TH AVE NE
Practice Address - Street 2:SUITE #102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4325
Practice Address - Country:US
Practice Address - Phone:425-453-2007
Practice Address - Fax:425-637-0047
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTDE 000104941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice