Active NPI
Ryan Etue II
- General Practice Dentistry
- Everett, WA
National Provider Identifier
1407976095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE00010977
- Practice address
- 305 SE Everett Mall Way
Suite 18
Everett, WA 98208-3250 - Phone
- (425) 513-1993
- Fax
- (425) 513-2132
- NPI assigned
- Mar 29, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D8648 | OR | |
| General Practice Dentistry | 1223G0001X | DE00010977 | WA | Primary |
Addresses
Primary practice location
305 SE Everett Mall Way
Suite 18
Everett, WA 98208-3250
Mailing address
305 SE Everett Mall Way
Suite 18
Everett, WA 98208-3250
Phone (425) 513-1993
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8648 | OR | MD | General Practice Dentistry |
| DE00010977 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270512000000",
"number": "1407976095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 SE EVERETT MALL WAY",
"address_2": "SUITE 18",
"city": "EVERETT",
"state": "WA",
"postal_code": "982083250",
"telephone_number": "425-513-1993",
"fax_number": "425-513-2132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 SE EVERETT MALL WAY",
"address_2": "SUITE 18",
"city": "EVERETT",
"state": "WA",
"postal_code": "982083250",
"telephone_number": "425-513-1993",
"fax_number": "425-513-2132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETUE",
"first_name": "RYAN",
"name_prefix": "Dr.",
"name_suffix": "II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2010-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D8648",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE00010977",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.