Provider Demographics
NPI:1477610848
Name:ADVANCED DIGITAL AND COSMETIS DENTISTRY, LLC
Entity Type:Organization
Organization Name:ADVANCED DIGITAL AND COSMETIS DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-363-8800
Mailing Address - Street 1:12333 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5600
Mailing Address - Country:US
Mailing Address - Phone:206-363-8800
Mailing Address - Fax:206-363-1198
Practice Address - Street 1:12333 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5600
Practice Address - Country:US
Practice Address - Phone:206-363-8800
Practice Address - Fax:206-363-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty