Provider Demographics
NPI:1659498301
Name:UW DENTISTS - FACULTY ENDODONTICS
Entity Type:Organization
Organization Name:UW DENTISTS - FACULTY ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PATIENT ACCOUNTS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-616-8794
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:P.O. BOX 357131
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-616-8794
Mailing Address - Fax:206-616-9520
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-616-8794
Practice Address - Fax:206-616-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty