Provider Demographics
NPI:1710073747
Name:SHIOTSU, GOICHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:GOICHI
Middle Name:
Last Name:SHIOTSU
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 1:2825 80TH AVE SE STE 3
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2977
Mailing Address - Country:US
Mailing Address - Phone:206-232-3600
Mailing Address - Fax:206-275-3025
Practice Address - Street 1:2825 80TH AVE SE STE 3
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2977
Practice Address - Country:US
Practice Address - Phone:206-232-3600
Practice Address - Fax:206-275-3025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics