Provider Demographics
NPI:1508246927
Name:DMG DENTAL DESIGN LLC
Entity Type:Organization
Organization Name:DMG DENTAL DESIGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYASKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:425-488-2345
Mailing Address - Street 1:1908 201ST PL SE
Mailing Address - Street 2:200
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8572
Mailing Address - Country:US
Mailing Address - Phone:425-488-2345
Mailing Address - Fax:425-489-4082
Practice Address - Street 1:1908 201ST PL SE
Practice Address - Street 2:200
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8572
Practice Address - Country:US
Practice Address - Phone:425-488-2345
Practice Address - Fax:425-489-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000070781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty