Provider Demographics
NPI:1861538639
Name:A DENTAL & DENTURE ASSOCIATES, LLC
Entity type:Organization
Organization Name:A DENTAL & DENTURE ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPD
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA PATRICIA
Authorized Official - Middle Name:COLLANTES
Authorized Official - Last Name:SUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-440-1500
Mailing Address - Street 1:11540 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6322
Mailing Address - Country:US
Mailing Address - Phone:206-440-1500
Mailing Address - Fax:206-440-1501
Practice Address - Street 1:11540 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6322
Practice Address - Country:US
Practice Address - Phone:206-440-1500
Practice Address - Fax:206-440-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000121122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1386799856OtherINDIVIDUAL NPI