Provider Demographics
NPI:1831142827
Name:PETER FORBER VANDERVEN PLLC
Entity type:Organization
Organization Name:PETER FORBER VANDERVEN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HARRELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-874-2583
Mailing Address - Street 1:34709 9TH AVE S
Mailing Address - Street 2:SUITE B-300
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8722
Mailing Address - Country:US
Mailing Address - Phone:253-874-2583
Mailing Address - Fax:253-874-8957
Practice Address - Street 1:34709 9TH AVE S
Practice Address - Street 2:SUITE B-300
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8722
Practice Address - Country:US
Practice Address - Phone:253-874-2583
Practice Address - Fax:253-874-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602515196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8860156Medicare PIN