Provider Demographics
NPI:1700054913
Name:TRIPPEL & AUDIA, PLLC
Entity Type:Organization
Organization Name:TRIPPEL & AUDIA, PLLC
Other - Org Name:BEL-RED ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-644-8000
Mailing Address - Street 1:14420 BEL RED RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3930
Mailing Address - Country:US
Mailing Address - Phone:425-644-8000
Mailing Address - Fax:425-644-4888
Practice Address - Street 1:14420 BEL RED RD STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3930
Practice Address - Country:US
Practice Address - Phone:425-644-8000
Practice Address - Fax:425-644-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091241223S0112X
WADE00054951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8800088Medicare PIN
WAG8800090Medicare PIN
WAG8800092Medicare PIN