Provider Demographics
NPI:1548379290
Name:IRWIN, TODD R (DMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:IRWIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E. 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-457-0489
Mailing Address - Fax:360-452-3288
Practice Address - Street 1:620 E. 8TH STREET
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-457-0489
Practice Address - Fax:360-452-3288
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA79281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice