Provider Demographics
NPI:1477640886
Name:UNIVERSITY OF WASHINGTON
Entity Type:Organization
Organization Name:UNIVERSITY OF WASHINGTON
Other - Org Name:UW DENTISTS - FACULTY PROS DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DEAN, CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:206-616-8794
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:P.O. BOX 357131
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-685-2276
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-685-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8852642Medicare PIN