Provider Demographics
NPI: | 1669858122 |
---|---|
Name: | WASHINGTON DENTAL CORPORATION, PC |
Entity Type: | Organization |
Organization Name: | WASHINGTON DENTAL CORPORATION, PC |
Other - Org Name: | BALLARD MODERN DENTISTRY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | MCGLASHAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 206-783-0330 |
Mailing Address - Street 1: | 17000 RED HILL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | IRVINE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92614-5626 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-845-8890 |
Mailing Address - Fax: | 949-474-1495 |
Practice Address - Street 1: | 1416 NW 46TH ST |
Practice Address - Street 2: | SUITE 106 |
Practice Address - City: | SEATTLE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98107-4622 |
Practice Address - Country: | US |
Practice Address - Phone: | 206-783-0330 |
Practice Address - Fax: | 206-783-4225 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-08-07 |
Last Update Date: | 2015-08-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |