Provider Demographics
NPI:1871337477
Name:VICKI FIDLER DDS PS
Entity type:Organization
Organization Name:VICKI FIDLER DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-850-5604
Mailing Address - Street 1:3626 NE 45TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5654
Mailing Address - Country:US
Mailing Address - Phone:206-526-1437
Mailing Address - Fax:
Practice Address - Street 1:3626 NE 45TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5654
Practice Address - Country:US
Practice Address - Phone:206-526-1437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental