Provider Demographics
NPI:1811303167
Name:AHDUT, YONATAN (DDS)
Entity type:Individual
Prefix:
First Name:YONATAN
Middle Name:
Last Name:AHDUT
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 1:6517 25TH AVE NE
Mailing Address - Street 2:APT. B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7160
Mailing Address - Country:US
Mailing Address - Phone:253-426-5821
Mailing Address - Fax:253-627-6766
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:SUITE B-3008
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-572-9777
Practice Address - Fax:253-627-6766
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60479557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist