Provider Demographics
NPI:1629098025
Name:RICHARD HWYNN DDS PLLC
Entity Type:Organization
Organization Name:RICHARD HWYNN DDS PLLC
Other - Org Name:BUFFALO SQUARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HUYLINH
Authorized Official - Last Name:HWYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-385-3839
Mailing Address - Street 1:3314 145TH PL SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5023
Mailing Address - Country:US
Mailing Address - Phone:425-385-3839
Mailing Address - Fax:425-337-9275
Practice Address - Street 1:13112 39TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5602
Practice Address - Country:US
Practice Address - Phone:425-385-3839
Practice Address - Fax:425-337-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000078701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty