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509 Olive Way Suite 637 Seattle WA 98101-1720 | |
| (206) 624-5115 | |
| (206) 623-4338 |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 509 Olive Way, Seattle, Washington |
| Authorized Official Name and Position | Brett J Nydegger (OWNER CEO) |
| Authorized Official Contact | 2066245115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
509 Olive Way Suite 637 Seattle WA 98101-1720 Ph: (206) 624-5115 | 509 Olive Way Suite 637 Seattle WA 98101-1720 Ph: (206) 624-5115 |
| NPI Number | 1962855494 |
|---|---|
| Provider Enumeration Date | 07/20/2016 |
| Last Update Date | 07/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962855494 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | DE60366761 (Washington) | Primary |
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