Provider Demographics
NPI:1801914098
Name:SODERGREN, RICHARD VICTOR (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VICTOR
Last Name:SODERGREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BENSON RD S
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4499
Mailing Address - Country:US
Mailing Address - Phone:425-277-5000
Mailing Address - Fax:425-277-1021
Practice Address - Street 1:2000 BENSON RD S
Practice Address - Street 2:SUITE 260
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4499
Practice Address - Country:US
Practice Address - Phone:425-277-5000
Practice Address - Fax:425-277-1021
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 84841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice