Provider Demographics
NPI:1437605979
Name:AESTHETIC AND GENERAL DENTISTRY
Entity Type:Organization
Organization Name:AESTHETIC AND GENERAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIDCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-854-6300
Mailing Address - Street 1:121 KENNEBECK AVE N
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4621
Mailing Address - Country:US
Mailing Address - Phone:253-854-6300
Mailing Address - Fax:
Practice Address - Street 1:121 KENNEBECK AVE N
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4621
Practice Address - Country:US
Practice Address - Phone:253-854-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA48451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty