Provider Demographics
NPI:1861606162
Name:THE GALLERY OF COSMETIC SURGERY
Entity type:Organization
Organization Name:THE GALLERY OF COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DYANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIDDAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-775-3561
Mailing Address - Street 1:3500 188TH ST SW
Mailing Address - Street 2:SUITE 670
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4716
Mailing Address - Country:US
Mailing Address - Phone:425-775-3561
Mailing Address - Fax:425-672-1385
Practice Address - Street 1:3500 188TH ST SW
Practice Address - Street 2:SUITE 670
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4716
Practice Address - Country:US
Practice Address - Phone:425-775-3561
Practice Address - Fax:425-672-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty