Provider Demographics
NPI:1679692503
Name:BUDA, ROBERT (DDS, MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BUDA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 STRANDER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2961
Mailing Address - Country:US
Mailing Address - Phone:206-575-1130
Mailing Address - Fax:206-575-1133
Practice Address - Street 1:411 STRANDER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2961
Practice Address - Country:US
Practice Address - Phone:206-575-1130
Practice Address - Fax:206-575-1133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000077871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028758Medicaid