Provider Demographics
NPI:1881189322
Name:AHDUT BEAN PLLC
Entity Type:Organization
Organization Name:AHDUT BEAN PLLC
Other - Org Name:GREEN LEAF KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YONATAN
Authorized Official - Middle Name:NIR
Authorized Official - Last Name:AHDUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-426-5821
Mailing Address - Street 1:4219 S OTHELLO ST STE 105D
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3873
Mailing Address - Country:US
Mailing Address - Phone:206-316-2351
Mailing Address - Fax:
Practice Address - Street 1:4219 S OTHELLO ST STE 105D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3873
Practice Address - Country:US
Practice Address - Phone:206-316-2351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60479557261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036949Medicaid