Provider Demographics
NPI: | 1952855538 |
---|---|
Name: | BRIAN DANSIE, D.D.S.,M.S.,P.L.L.C. |
Entity Type: | Organization |
Organization Name: | BRIAN DANSIE, D.D.S.,M.S.,P.L.L.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TERESA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KARINEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 425-255-5532 |
Mailing Address - Street 1: | 364 RENTON CENTER WAY SW |
Mailing Address - Street 2: | SUITE #62 |
Mailing Address - City: | RENTON |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98057-5896 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 364 RENTON CENTER WAY SW |
Practice Address - Street 2: | SUITE #62 |
Practice Address - City: | RENTON |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98057-5896 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-255-5532 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-08-11 |
Last Update Date: | 2016-08-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 60356126 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |