Provider Demographics
NPI:1871617944
Name:PAK, BERNARD S (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:S
Last Name:PAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 11TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5326
Mailing Address - Country:US
Mailing Address - Phone:425-893-9500
Mailing Address - Fax:425-893-8022
Practice Address - Street 1:312 11TH AVE W STE 101
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5326
Practice Address - Country:US
Practice Address - Phone:425-893-9500
Practice Address - Fax:425-893-8022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000077441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice