Provider Demographics
NPI:1962657429
Name:SUSAN A. KIRALY, DDS, PS
Entity Type:Organization
Organization Name:SUSAN A. KIRALY, DDS, PS
Other - Org Name:SPRING STREET DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:KIRALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-378-5550
Mailing Address - Street 1:815 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-9311
Mailing Address - Country:US
Mailing Address - Phone:360-378-5550
Mailing Address - Fax:360-370-5192
Practice Address - Street 1:815 SPRING ST
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-9311
Practice Address - Country:US
Practice Address - Phone:360-378-5550
Practice Address - Fax:360-370-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7617261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602263331OtherSTATE UNIFIED BUSINESS ID