Basic Information
Provider Information
NPI: 1396976239
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDERSON ELTER
FirstName: AARIKA
MiddleName: DAWN
NamePrefix:  
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ANDERSON
OtherFirstName: AARIKA
OtherMiddleName: DAWN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: DMD
OtherLastNameType: 1
Mailing Information
Address1: 1200 12TH AVE S
Address2: SUITE 901
City: SEATTLE
State: WA
PostalCode: 981442712
CountryCode: US
TelephoneNumber: 2065483114
FaxNumber: 2067626355
Practice Location
Address1: 9245 RAINIER AVE S
Address2:  
City: SEATTLE
State: WA
PostalCode: 981185569
CountryCode: US
TelephoneNumber: 2067228444
FaxNumber: 2067216310
Other Information
ProviderEnumerationDate: 07/27/2009
LastUpdateDate: 01/21/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001XDE60101692WAY Dental ProvidersDentistGeneral Practice

No ID Information.


Home