Provider Demographics
NPI:1316239098
Name:DAVID R. ATHERTON DDS PLLC
Entity type:Organization
Organization Name:DAVID R. ATHERTON DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:ATHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-869-1830
Mailing Address - Street 1:17130 AVONDALE WAY SUITE 118
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4455
Mailing Address - Country:US
Mailing Address - Phone:425-869-1830
Mailing Address - Fax:425-869-9836
Practice Address - Street 1:17130 AVONDALE WAY SUITE 118
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4455
Practice Address - Country:US
Practice Address - Phone:425-869-1830
Practice Address - Fax:425-869-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA056371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty