Provider Demographics
NPI:1245783190
Name:DAHLKE ORTHODONTICS LLC
Entity type:Organization
Organization Name:DAHLKE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:253-912-9383
Mailing Address - Street 1:1100 STATION DR
Mailing Address - Street 2:STE 281
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9763
Mailing Address - Country:US
Mailing Address - Phone:253-912-9383
Mailing Address - Fax:253-912-1480
Practice Address - Street 1:1100 STATION DR
Practice Address - Street 2:STE 281
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9763
Practice Address - Country:US
Practice Address - Phone:253-912-9383
Practice Address - Fax:253-912-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 606154111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty