Active NPI
Michael Anthony Dire, DDS
- Dentist
- Everett, WA
National Provider Identifier
1619030657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4072
- Practice address
- 5704 Evergreen Way
A
Everett, WA 98203 - Phone
- (425) 290-7550
- Fax
- (425) 290-3940
- NPI assigned
- Dec 19, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4072 | WA | Primary |
Addresses
Primary practice location
5704 Evergreen Way
A
Everett, WA 98203
Mailing address
5704 Evergreen Way
A
Everett, WA 98203
Phone (425) 290-7550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5391206 | Medicaid | WA |
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 |
|---|---|---|---|
| 4072 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619030657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5704 EVERGREEN WAY",
"address_2": "A",
"city": "EVERETT",
"state": "WA",
"postal_code": "98203",
"telephone_number": "425-290-7550",
"fax_number": "425-290-3940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5704 EVERGREEN WAY",
"address_2": "A",
"city": "EVERETT",
"state": "WA",
"postal_code": "98203",
"telephone_number": "425-290-7550",
"fax_number": "425-290-3940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIRE",
"first_name": "MICHAEL",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "4072",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5391206",
"state": "WA"
}
],
"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 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.