Provider Demographics
NPI:1578070777
Name:DANIEL SCHRUTH DDS PLLC
Entity Type:Organization
Organization Name:DANIEL SCHRUTH DDS PLLC
Other - Org Name:RAINIER VALLEY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-721-5500
Mailing Address - Street 1:4716 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1658
Mailing Address - Country:US
Mailing Address - Phone:206-721-5500
Mailing Address - Fax:
Practice Address - Street 1:4716 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1658
Practice Address - Country:US
Practice Address - Phone:206-721-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602984211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE60298421OtherDENTAL BOARD