Provider Demographics
NPI:1740377670
Name:PACKARD, DAVID K (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:PACKARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3963
Mailing Address - Country:US
Mailing Address - Phone:509-577-8277
Mailing Address - Fax:509-573-4858
Practice Address - Street 1:1501 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3963
Practice Address - Country:US
Practice Address - Phone:509-577-8277
Practice Address - Fax:509-573-4858
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA76921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5023478Medicaid
WA92560941OtherTPIN
WA7692OtherSTATE LICENSE
WA112287OtherLABOR & INDUSTRIES
WA8923148OtherCRIME VICTIMS
WA481926OtherUNITED CONCORDIA
WA481926OtherUNITED CONCORDIA