Provider Demographics
NPI:1649724220
Name:GOICHI SHIOTSU DDS P S
Entity type:Organization
Organization Name:GOICHI SHIOTSU DDS P S
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GOICHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIOTSU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS P S
Authorized Official - Phone:206-232-3600
Mailing Address - Street 1:2825 80TH AVE SE STE 3
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2977
Mailing Address - Country:US
Mailing Address - Phone:206-232-3600
Mailing Address - Fax:
Practice Address - Street 1:2825 80TH AVE SE STE 3
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2977
Practice Address - Country:US
Practice Address - Phone:206-232-3600
Practice Address - Fax:206-275-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8994332BC3200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty