Provider Demographics
NPI:1487866612
Name:WALLEN, BRETT ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ANDREW
Last Name:WALLEN
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 1:118 SW 330TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6185
Mailing Address - Country:US
Mailing Address - Phone:253-835-2296
Mailing Address - Fax:253-835-7103
Practice Address - Street 1:118 SW 330TH ST STE 103
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-6185
Practice Address - Country:US
Practice Address - Phone:253-835-2296
Practice Address - Fax:253-835-7103
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice