Provider Demographics
NPI:1447696752
Name:DERICK W. HAHN D.D.S., PLLC
Entity type:Organization
Organization Name:DERICK W. HAHN D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-778-0592
Mailing Address - Street 1:720 S 38TH CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5894
Mailing Address - Country:US
Mailing Address - Phone:206-778-0592
Mailing Address - Fax:
Practice Address - Street 1:1107 SW GRADY WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5217
Practice Address - Country:US
Practice Address - Phone:425-226-9270
Practice Address - Fax:425-254-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60035932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1699929167OtherTYPE 1 NPI NUMBER