Provider Demographics
NPI:1699988808
Name:BARRY A FEDER DDS PS
Entity type:Organization
Organization Name:BARRY A FEDER DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-392-7541
Mailing Address - Street 1:450 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2483
Mailing Address - Country:US
Mailing Address - Phone:425-392-7541
Mailing Address - Fax:425-391-3869
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-392-7541
Practice Address - Fax:425-391-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5503602Medicaid