Provider Demographics
NPI:1568694867
Name:ALEXANDER SHOR OR EASTLAKE DENTAL
Entity Type:Organization
Organization Name:ALEXANDER SHOR OR EASTLAKE DENTAL
Other - Org Name:ALEXANDER SHOR DMD, MSD, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:206-325-7456
Mailing Address - Street 1:1500 FAIRVIEW AVENUE EAST
Mailing Address - Street 2:STE. #300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:206-325-7456
Mailing Address - Fax:206-323-6273
Practice Address - Street 1:1500 FAIRVIEW AVENUE EAST
Practice Address - Street 2:STE. #300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-325-7456
Practice Address - Fax:206-323-6273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXANDER SHOR, DMD, MSD, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE9117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty