Ty William Etheridge, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00008770 Issued in WA

Practice address

3130 E Madison St
Suite 103
Seattle, WA 98112-4264

Phone

(206) 323-0990

Fax

(206) 323-0977

NPI assigned

Apr 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Etheridge Family Dentistry

  • Endodontics
  • Seattle, WA
  • NPI 1093147068
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720202401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3130 E MADISON ST",
            "address_2": "SUITE 103",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124264",
            "telephone_number": "206-323-0990",
            "fax_number": "206-323-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 E MADISON ST",
            "address_2": "SUITE 103",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124264",
            "telephone_number": "206-323-0990",
            "fax_number": "206-323-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "TY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00008770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felecity Estrella, PHARMD
• Ali Etemad, DDS
• Ethereal Anesthesia PLLC
• Ethereal Emdr PLLC
• Etheridge Family Dentistry
• Ethiopian Community in Seattle
• Bradley M Etier
• Anusha Reddy Etikala, BDS, MS
• Laura Adrienne Etling
• William Strickler Etnyre, PHD,LICS

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• 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.

Verify at the official NPI Registry.