Provider Demographics
NPI:1306270905
Name:ADVANCED DERMATOLOGY AND LASER INSTITUTE OF SEATTLE PLLC
Entity type:Organization
Organization Name:ADVANCED DERMATOLOGY AND LASER INSTITUTE OF SEATTLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-402-4797
Mailing Address - Street 1:PO BOX 66596
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0596
Mailing Address - Country:US
Mailing Address - Phone:206-402-4797
Mailing Address - Fax:206-402-4801
Practice Address - Street 1:4915 25TH AVE NE STE 207W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5668
Practice Address - Country:US
Practice Address - Phone:206-962-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty