Provider Demographics
NPI:1821327131
Name:TREVOR TSUCHIKAWA DDS
Entity Type:Organization
Organization Name:TREVOR TSUCHIKAWA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUCHIKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-852-6835
Mailing Address - Street 1:302 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5713
Mailing Address - Country:US
Mailing Address - Phone:253-520-3866
Mailing Address - Fax:253-520-3844
Practice Address - Street 1:302 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5713
Practice Address - Country:US
Practice Address - Phone:253-520-3866
Practice Address - Fax:253-520-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600359451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty