# BAKHTIAR ARDI PRIBADI DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Autumnwood Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144533142
- **Authorized official:** DR. BAKHTIAR ARDI PRIBADI DDS (OWNER)
- **Authorized official phone:** (360) 474-9163

## Contact information

- **Practice address:** 430 N WEST AVE STE 1, ARLINGTON, WA 98223-1539
- **Practice address phone:** (360) 474-9163
- **Practice address fax:** (360) 474-9180
- **Mailing address:** 430 N WEST AVE STE 1, ARLINGTON, WA 98223-1539
- **Mailing address phone:** (360) 474-9163
- **Mailing address fax:** (360) 474-9180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DE00010465 | WA | Yes |

## Other

- **Enumeration date:** 07/19/2010
- **Last updated:** 07/29/2010