Provider Demographics
NPI:1790138634
Name:DENTAL ARTS
Entity Type:Organization
Organization Name:DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STANFORD
Authorized Official - Last Name:WAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-378-5580
Mailing Address - Street 1:278 A ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-7178
Mailing Address - Country:US
Mailing Address - Phone:360-378-5580
Mailing Address - Fax:360-378-5619
Practice Address - Street 1:278 A ST
Practice Address - Street 2:SUITE #1
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7178
Practice Address - Country:US
Practice Address - Phone:360-378-5580
Practice Address - Fax:360-378-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000094361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty