| South Sound Oral Medicine | |
|
34709 9th Ave S Suite B-300 Federal Way WA 98003-8722 | |
| (253) 874-2583 | |
| (253) 874-8957 |
| Full Name | South Sound Oral Medicine |
|---|---|
| Speciality | Dentist |
| Location | 34709 9th Ave S, Federal Way, Washington |
| Authorized Official Name and Position | Sandra Louise Harrelson (FINANCIAL COORDINATOR) |
| Authorized Official Contact | 2538742583 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Sound Oral Medicine 34709 9th Ave S Suite B-300 Federal Way WA 98003-8722 Ph: (253) 874-2583 | South Sound Oral Medicine 34709 9th Ave S Suite B-300 Federal Way WA 98003-8722 Ph: (253) 874-2583 |
| NPI Number | 1831142827 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 03/25/2013 |
| Medicare PECOS PAC ID | 1052323144 |
|---|---|
| Medicare Enrollment ID | O20060607000116 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831142827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 602515196 (Washington) | Primary |
| Provider Name | Peter F Vanderven |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750334199 PECOS PAC ID: 4284528589 Enrollment ID: I20040209000872 |
| Provider Name | Simin Faghih Nakhjiri |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1043263585 PECOS PAC ID: 3870546088 Enrollment ID: I20060828000149 |
| Provider Name | Stuart Taylor |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790936730 PECOS PAC ID: 0244390201 Enrollment ID: I20081203000837 |
| Provider Name | Rashmi Malhotra |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1043668395 PECOS PAC ID: 5597038430 Enrollment ID: I20170829001691 |
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