| Id Dental | |
|
720 8th Ave S 100 Seattle WA 98104-3032 | |
| (206) 788-3700 | |
| (206) 788-3704 |
| Full Name | Id Dental |
|---|---|
| Speciality | Dentist |
| Location | 720 8th Ave S, Seattle, Washington |
| Authorized Official Name and Position | Hermes Shahbazian (CFO) |
| Authorized Official Contact | 2067883618 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Dental Po Box 3007 Seattle WA 98114-3007 Ph: (206) 788-3600 | Id Dental 720 8th Ave S 100 Seattle WA 98104-3032 Ph: (206) 788-3700 |
| NPI Number | 1356428601 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 03/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356428601 | NPI | - | NPPES |
| 5023353 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 600436519 (Washington) | Primary |
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