Provider Demographics
NPI:1316094352
Name:CAVE, BRIAN TYLER (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:TYLER
Last Name:CAVE
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 1:13715 BEL-RED ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-643-2818
Mailing Address - Fax:425-746-8041
Practice Address - Street 1:13715 BEL-RED ROAD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-643-2818
Practice Address - Fax:425-746-8041
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA912023252OtherTAX ID NUMBER