ETHERIDGE FAMILY DENTISTRY (NPI# 1093147068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093147068 |
| Entity Type | Organization |
| Organization Name | ETHERIDGE FAMILY DENTISTRY |
| Practice Address |
3130 E Madison St Ste 103 Seattle WA 98112-4221 |
| Practice Telephone | 2063230990 |
| Mailing Telephone | 2063230990 |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2013-08-01 |
| Authorized Official Name | LORI LIU (OFFICE MANAGER) |
| Authorized Official Telephone | 2063230990 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers | ||
| N | 1223P0700X |
Dentist Specialization: Prosthodontics |
Dental Providers | ||
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
Dental Providers |
| Street Address |
3130 E MADISON ST STE 103 |
| City | SEATTLE |
| State | WA |
| Zip Code | 98112-4221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891254991 | Justin Jeng-young Fu | Student in an Organized Health Care Education/Training Program | 125 16 Th Ave E, Csb 545, Seattle, WA 98112 | 2019-03-18 |
| 1275015604 | Eyewear Gallery LLC | Optometrist | 3121 E. Madison St Ste 102, Seattle, WA 98112 | 2018-09-01 |
| 1336637081 | Oh Plastic and Reconstructive Surgery LLC | Plastic Surgery | 602 27th Ave E, Seattle, WA 98112 | 2018-04-27 |
| 1992228191 | John Joseph Folta | Chiropractor | 3121 E Madison St Ste 103a, Seattle, WA 98112 | 2017-07-19 |
| 1083161061 | Sheick Toure | Counselor | 122 16 Ave E, Seattle, WA 98112 | 2016-09-07 |
| 1457721805 | Jessica Donovan | Audiologist | 201 16th Ave E # Cmb, Seattle, WA 98112 | 2015-09-29 |
| 1952777427 | Ronald Berenson | Physiological Laboratory | 2032 41st Avenue, Seattle, WA 98112 | 2015-08-19 |
| 1225419005 | Adrienne Foley | Counselor | 1833 40th Ave. E., Seattle, WA 98112 | 2015-06-17 |
| 1952721771 | Ling Guo | Internal Medicine | Kaiser Permanente Central Hospital Building, 126 16th Ave E, Seattle, WA 98112 | 2014-04-19 |
| 1134548068 | Anne Gayman | Family Medicine | 125 16th Avenue East, Csb-540, Group Health Family Medicine Residency, Seattle, WA 98112 | 2014-04-08 |
| Find all providers in zip 98112 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881077907 | David Jungjoo Kang | Dentist | 509 Olive Way Ste 1633, Seattle, WA 98101-1770 | 2015-07-07 |
| 1215356639 | Callie M Smithson | Dentist | 2743 California Ave Sw Unit 200, Seattle, WA 98116-2495 | 2014-04-14 |
| 1881977346 | Victor K Marfo | Dentist | 10101 8th Ave S Apt L118, Seattle, WA 98168-5521 | 2011-09-21 |
| 1770819245 | Carina L Lea | Dentist | 701 N 34th St Ste 210, Seattle, WA 98103-3414 | 2009-10-19 |
| 1295901734 | Don Henry Pratten | Dentist | 5016 California Ave Sw, #101, Seattle, WA 98136-1232 | 2008-05-05 |
| 1417167156 | Theodore F Pilot | Dentist | 1229 Madison St Ste 1140, Seattle, WA 98104-3587 | 2007-05-23 |
| 1720100290 | Matthew Arthur Mandel | Dentist | 4341 Roosevelt Way Ne, Seattle, WA 98105-4717 | 2007-04-04 |
| 1144349119 | Mark Earl Germack | Dentist | 720 Olive Way Ste 835, Seattle, WA 98101-1853 | 2007-03-28 |
| 1013094390 | Lynnetta Jeanne Odell | Dentist | 509 Olive Way Ste 1511, Seattle, WA 98101-1749 | 2006-11-01 |
| 1881704427 | Rachelle S Hecht | Dentist | 5016 California Ave Sw # 101, Seattle, WA 98136-1232 | 2006-08-30 |
| Find all providers in SEATTLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.