Provider Demographics
NPI:1215447677
Name:DR. SHUR DENTAL
Entity type:Organization
Organization Name:DR. SHUR DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-741-2030
Mailing Address - Street 1:16108 ASH WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8781
Mailing Address - Country:US
Mailing Address - Phone:425-741-2030
Mailing Address - Fax:425-741-2026
Practice Address - Street 1:16108 ASH WAY STE 202
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8781
Practice Address - Country:US
Practice Address - Phone:425-741-2030
Practice Address - Fax:425-741-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000102971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1001094Medicaid