Provider Demographics
NPI:1992134068
Name:BELLINGHAM DENTAL GROUP
Entity type:Organization
Organization Name:BELLINGHAM DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARKER JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-734-6190
Mailing Address - Street 1:1100 ELLIS ST
Mailing Address - Street 2:STE 1
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5238
Mailing Address - Country:US
Mailing Address - Phone:360-734-6190
Mailing Address - Fax:360-733-2120
Practice Address - Street 1:1100 ELLIS ST
Practice Address - Street 2:STE 1
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5238
Practice Address - Country:US
Practice Address - Phone:360-734-6190
Practice Address - Fax:360-733-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60099952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty