Provider Demographics
NPI:1962855494
Name:BRETT J NYDEGGER DDS MS
Entity Type:Organization
Organization Name:BRETT J NYDEGGER DDS MS
Other - Org Name:ENDODONTIC SPECIALISTS SEATTLE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:J
Authorized Official - Last Name:NYDEGGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:206-624-5115
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE 637
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1720
Mailing Address - Country:US
Mailing Address - Phone:206-624-5115
Mailing Address - Fax:206-623-4338
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 637
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-624-5115
Practice Address - Fax:206-623-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603667611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty