Provider Demographics
NPI:1528212354
Name:ALAN F. ALTMAN, DDS, PC
Entity Type:Organization
Organization Name:ALAN F. ALTMAN, DDS, PC
Other - Org Name:RENAISSANCE DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-752-4422
Mailing Address - Street 1:2302 S UNION AVE STE A6
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1332
Mailing Address - Country:US
Mailing Address - Phone:253-752-4422
Mailing Address - Fax:253-759-5724
Practice Address - Street 1:2302 S UNION AVE STE A6
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1332
Practice Address - Country:US
Practice Address - Phone:253-752-4422
Practice Address - Fax:253-759-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5688261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5688OtherWASHINGTON STATE DENTAL LICENSE