Provider Demographics
NPI:1538845276
Name:WEDGWOOD FAMILY DENTISTRY
Entity type:Organization
Organization Name:WEDGWOOD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMEDREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATASHZAREH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-526-5600
Mailing Address - Street 1:7030 35TH AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5917
Mailing Address - Country:US
Mailing Address - Phone:205-526-5600
Mailing Address - Fax:
Practice Address - Street 1:7030 35TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5917
Practice Address - Country:US
Practice Address - Phone:205-526-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental