Provider Demographics
NPI:1104556042
Name:SOPER ENTERPRISES MERCER ISLAND, PLLC
Entity type:Organization
Organization Name:SOPER ENTERPRISES MERCER ISLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PLLC
Authorized Official - Phone:425-747-9494
Mailing Address - Street 1:14575 NE BEL RED RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3908
Mailing Address - Country:US
Mailing Address - Phone:425-375-8923
Mailing Address - Fax:
Practice Address - Street 1:2817 80TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2913
Practice Address - Country:US
Practice Address - Phone:206-232-9600
Practice Address - Fax:206-232-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty