Provider Demographics
NPI:1609321231
Name:KENT DE VIGNE, DDS, PLLC
Entity Type:Organization
Organization Name:KENT DE VIGNE, DDS, PLLC
Other - Org Name:PIKE PLACE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:DE VIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:206-625-1267
Mailing Address - Street 1:93 PIKE ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2052
Mailing Address - Country:US
Mailing Address - Phone:206-625-1267
Mailing Address - Fax:206-625-9017
Practice Address - Street 1:93 PIKE ST
Practice Address - Street 2:SUITE 309
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2052
Practice Address - Country:US
Practice Address - Phone:206-625-1267
Practice Address - Fax:206-625-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7034261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental