Provider Demographics
NPI:1578727269
Name:ATKINSON & KAOPUA, PS
Entity Type:Organization
Organization Name:ATKINSON & KAOPUA, PS
Other - Org Name:ALBRIGHT FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-766-4192
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-0296
Mailing Address - Country:US
Mailing Address - Phone:360-766-4192
Mailing Address - Fax:360-766-4192
Practice Address - Street 1:111 SE EVERETT MALL WAY STE D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3208
Practice Address - Country:US
Practice Address - Phone:425-267-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000084721223G0001X
WADE600235321223G0001X
WADE00091491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5052378Medicaid
WA50519852Medicaid