Basic Information
| Provider Information | |||||||||
| NPI: | 1134544075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 S STILLAGUAMISH AVE | ||||||||
| Address2: | CHC OF SNOHOMISH COUNTY | ||||||||
| City: | ARLINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982231652 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 S STILLAGUAMISH AVE | ||||||||
| Address2: | CHC OF SNOHOMISH COUNTY | ||||||||
| City: | ARLINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982231652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605725430 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2014 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DR60468203 | WA | Y | Dental Providers | Dentist | 122300000X | DE 60551302 | WA | N | Dental Providers | Dentist |
No ID Information.