Active NPI
Philip J Etheredge, DDS
- General Practice Dentistry
- Kirkland, WA
National Provider Identifier
1093813800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6091
- Practice address
- 13118 121St Way NE
Suite 102
Kirkland, WA 98034 - Phone
- (425) 822-0505
- Fax
- (425) 825-5661
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6091 | WA | Primary |
Addresses
Primary practice location
13118 121St Way NE
Suite 102
Kirkland, WA 98034
Mailing address
13118 121St Way NE
Suite 102
Kirkland, WA 98034
Phone (425) 822-0505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chet Jenkins PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093813800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13118 121ST WAY NE",
"address_2": "SUITE 102",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "98034",
"telephone_number": "425-822-0505",
"fax_number": "425-825-5661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13118 121ST WAY NE",
"address_2": "SUITE 102",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "98034",
"telephone_number": "425-822-0505",
"fax_number": "425-825-5661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHEREDGE",
"first_name": "PHILIP",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "6091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.