Provider Demographics
NPI:1710044458
Name:DIRE, ANTHONY GUY (DDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GUY
Last Name:DIRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 STRANDER BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2935
Mailing Address - Country:US
Mailing Address - Phone:206-575-1125
Mailing Address - Fax:206-575-2825
Practice Address - Street 1:411 STRANDER BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2935
Practice Address - Country:US
Practice Address - Phone:206-575-1125
Practice Address - Fax:206-575-2825
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice