Provider Demographics
NPI:1265441158
Name:PASSMORE, NORMOND J (DDS)
Entity type:Individual
Prefix:DR
First Name:NORMOND
Middle Name:J
Last Name:PASSMORE
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 1:270 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328
Mailing Address - Country:US
Mailing Address - Phone:509-382-1260
Mailing Address - Fax:509-382-1258
Practice Address - Street 1:270 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328
Practice Address - Country:US
Practice Address - Phone:509-382-1260
Practice Address - Fax:509-382-1258
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9696OtherWASHINGTON DENTAL SERVICE
WA5046909Medicaid
PA3236OtherREGENCE BLUE SHIELD