Provider Demographics
NPI:1316085541
Name:NASH, RICHARD WILSON (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILSON
Last Name:NASH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W FAIRHAVEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1062
Mailing Address - Country:US
Mailing Address - Phone:360-757-0651
Mailing Address - Fax:360-757-3741
Practice Address - Street 1:205 W FAIRHAVEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1062
Practice Address - Country:US
Practice Address - Phone:360-757-0651
Practice Address - Fax:360-757-3741
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00047791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice