Provider Demographics
NPI:1689651234
Name:VAN NESS, ALLAN LESLIE (DDS, MSD)
Entity Type:Individual
Prefix:MS
First Name:ALLAN
Middle Name:LESLIE
Last Name:VAN NESS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:ALLAN
Other - Middle Name:L
Other - Last Name:VAN NESS, DDS, PS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18323 98TH AVE NE
Mailing Address - Street 2:STE #1
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3358
Mailing Address - Country:US
Mailing Address - Phone:425-485-9332
Mailing Address - Fax:425-486-0935
Practice Address - Street 1:18323 98TH AVE NE
Practice Address - Street 2:STE #1
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3358
Practice Address - Country:US
Practice Address - Phone:425-485-9332
Practice Address - Fax:425-486-0935
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000035061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics