Provider Demographics
NPI:1134380629
Name:KIM A ANARDI DDS MAGD PC
Entity type:Organization
Organization Name:KIM A ANARDI DDS MAGD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MAGD PC
Authorized Official - Phone:853-833-1070
Mailing Address - Street 1:1320 8TH ST NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4589
Mailing Address - Country:US
Mailing Address - Phone:253-833-1070
Mailing Address - Fax:253-735-3893
Practice Address - Street 1:1320 8TH ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4589
Practice Address - Country:US
Practice Address - Phone:253-833-1070
Practice Address - Fax:253-735-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty