Provider Demographics
NPI:1932217403
Name:DORMANS, DAVID WILLIAM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:DORMANS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-0486
Mailing Address - Country:US
Mailing Address - Phone:360-299-0404
Mailing Address - Fax:360-299-0606
Practice Address - Street 1:6803 BIG CEDAR LN
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8304
Practice Address - Country:US
Practice Address - Phone:360-299-0404
Practice Address - Fax:360-299-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008184122300000X, 1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5038542Medicaid