Provider Demographics
NPI:1376648717
Name:DERMATOLOGY & LASER CENTER NW
Entity type:Organization
Organization Name:DERMATOLOGY & LASER CENTER NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-676-1470
Mailing Address - Street 1:905 SQUALICUM WAY
Mailing Address - Street 2:STE. 101
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-676-1470
Mailing Address - Fax:360-676-0377
Practice Address - Street 1:905 SQUALICUM WAY STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2076
Practice Address - Country:US
Practice Address - Phone:360-676-1470
Practice Address - Fax:360-676-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty