Provider Demographics
NPI:1972627537
Name:FORD, DAVID BRINTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRINTON
Last Name:FORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4266
Mailing Address - Country:US
Mailing Address - Phone:206-407-6219
Mailing Address - Fax:
Practice Address - Street 1:1900 S PUGET DR
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4421
Practice Address - Country:US
Practice Address - Phone:425-228-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000100341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice