Provider Demographics
NPI:1205974672
Name:REPANICH, FRANK JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOHN
Last Name:REPANICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4436
Mailing Address - Country:US
Mailing Address - Phone:360-734-9928
Mailing Address - Fax:
Practice Address - Street 1:2814 FLINT ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4436
Practice Address - Country:US
Practice Address - Phone:360-734-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5672WAOtherDELTA DENTAL PROVIDER NUM
WA5098009Medicaid
WA848596OtherUNITED CONCORDIA PROVIDER
WA848596OtherUNITED CONCORDIA PROVIDER