Provider Demographics
NPI:1124426846
Name:TEETH R US
Entity type:Organization
Organization Name:TEETH R US
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MYASKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-892-9096
Mailing Address - Street 1:1908 201 PL SE SUITE #201
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:425-892-9096
Mailing Address - Fax:
Practice Address - Street 1:1908 201 PL SE SUITE #201
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-892-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEETH R US LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty