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4716 Rainier Ave S Seattle WA 98118-1658 | |
| (206) 721-5500 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4716 Rainier Ave S, Seattle, Washington |
| Authorized Official Name and Position | Daniel Schruth (OWNER) |
| Authorized Official Contact | 2067215500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4716 Rainier Ave S Seattle WA 98118-1658 Ph: (206) 721-5500 | 4716 Rainier Ave S Seattle WA 98118-1658 Ph: (206) 721-5500 |
| NPI Number | 1578070777 |
|---|---|
| Provider Enumeration Date | 01/09/2018 |
| Last Update Date | 01/09/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578070777 | NPI | - | NPPES |
| DE60298421 | Other | WA | DENTAL BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DE60298421 (Washington) | Primary |
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