Active NPI
Mark L Dire, D.D.S.
- General Practice Dentistry
- Bellevue, WA
National Provider Identifier
1669566840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4610
- Practice address
- 12917 SE 38TH St
#202
Bellevue, WA 98006-1349 - Phone
- (425) 747-8052
- Fax
- (425) 562-7222
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 4610 | WA | Primary |
Addresses
Primary practice location
12917 SE 38TH St
#202
Bellevue, WA 98006-1349
Mailing address
14259 209TH Ave NE
Woodinville, WA 98077-5664
Phone (425) 883-7108
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 |
|---|---|---|---|
| 4610 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark L Dire DDS P.S. | General Practice | 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": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669566840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14259 209TH AVE NE",
"city": "WOODINVILLE",
"state": "WA",
"postal_code": "980775664",
"telephone_number": "425-883-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12917 SE 38TH ST",
"address_2": "#202",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980061349",
"telephone_number": "425-747-8052",
"fax_number": "425-562-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIRE",
"first_name": "MARK",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "4610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, 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.