# PLASTIC SURGERY NORTHWEST ASC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093787715
- **Authorized official:** GAVIN M DRY MD (OWNER)
- **Authorized official phone:** (425) 821-6000

## Contact information

- **Practice address:** 13114 120TH AVE NE, KIRKLAND, WA 98034-3014
- **Practice address phone:** (425) 821-6000
- **Practice address fax:** (425) 820-6288
- **Mailing address:** 13114 120TH AVE NE, KIRKLAND, WA 98034-3014
- **Mailing address phone:** (425) 821-6000
- **Mailing address fax:** (425) 820-6288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | WA | Yes |

## Other

- **Enumeration date:** 02/06/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0151861 | LABOR INDUSTRIES | WA |