Provider Demographics
NPI:1801383484
Name:DANSIE PEDIATRIC, PLLC
Entity Type:Organization
Organization Name:DANSIE PEDIATRIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DANSIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-255-5532
Mailing Address - Street 1:3316 56TH ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98338
Mailing Address - Country:US
Mailing Address - Phone:425-255-5532
Mailing Address - Fax:425-255-1658
Practice Address - Street 1:3316 56TH ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98338
Practice Address - Country:US
Practice Address - Phone:425-255-5532
Practice Address - Fax:425-255-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60356126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty