Bakhtiar Ardi Pribadi DDS PS

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DE00010465 Issued in WA

Legal business name

BAKHTIAR ARDI PRIBADI DDS PS

Practice address

430 N West Ave Ste 1
Arlington, WA 98223-1539

Phone

(360) 474-9163

Fax

(360) 474-9180

NPI assigned

Jul 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bakhtiar Ardi Pribadi, DDS

Title

Owner

Phone

(360) 474-9163

Specialties & licenses 1

Addresses

Other names 1

• Autumnwood Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280361600000",
    "number": "1144533142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 N WEST AVE STE 1",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982231539",
            "telephone_number": "360-474-9163",
            "fax_number": "360-474-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 N WEST AVE STE 1",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982231539",
            "telephone_number": "360-474-9163",
            "fax_number": "360-474-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKHTIAR ARDI PRIBADI DDS PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-19",
        "last_updated": "2010-07-29",
        "status": "A",
        "authorized_official_last_name": "PRIBADI",
        "authorized_official_first_name": "BAKHTIAR",
        "authorized_official_middle_name": "ARDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-474-9163",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "DE00010465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumnwood Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexa Magdalena Ayala
• Azra Grudic Consulting and Counseling
• Koung Baek, DACM
• Korynn Loree Baird, AAC-R
• Natalia V Bajenova, MD
• Balanced Body Health & Wellness PLLC
• Janelle Renee Bales, MPT
• Bruce J Ballon, M.D.
• Michael R Banitt, M.D.
• Diana Barber, RNFA

• All providers in Arlington, WA
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.