Basic Information
| Provider Information | |||||||||
| NPI: | 1841592474 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHILIP R HOWARD DDS AND TARA M SULLIVAN DDS PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOWARD AND SULLIVAN FAMILY DENTISTRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4520 42ND AVE SW STE 23 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069381777 | ||||||||
| FaxNumber: | 2069380740 | ||||||||
| Practice Location | |||||||||
| Address1: | 4520 42ND AVE SW STE 23 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069381777 | ||||||||
| FaxNumber: | 2069380740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2010 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2069381777 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE 10978 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.