Provider Demographics
NPI:1750736401
Name:DALE, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 SOUTH 238TH PLACE
Mailing Address - Street 2:APT U205
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032
Mailing Address - Country:US
Mailing Address - Phone:318-623-3563
Mailing Address - Fax:
Practice Address - Street 1:6302 S 238TH PL
Practice Address - Street 2:APT U205
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032
Practice Address - Country:US
Practice Address - Phone:318-623-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other