| Chc Of Snohomish County 112th Dental | |
|
1019 112th St Sw Everett WA 98204 | |
| (425) 551-6001 | |
| (425) 551-6008 |
| Full Name | Chc Of Snohomish County 112th Dental |
|---|---|
| Speciality | Dentist |
| Location | 1019 112th St Sw, Everett, Washington |
| Authorized Official Name and Position | Kenneth M Green (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4257893700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chc Of Snohomish County 112th Dental Po Box 13060 Everett WA 98206-3060 Ph: (425) 789-3700 | Chc Of Snohomish County 112th Dental 1019 112th St Sw Everett WA 98204 Ph: (425) 551-6001 |
| NPI Number | 1649460288 |
|---|---|
| Provider Enumeration Date | 07/30/2007 |
| Last Update Date | 07/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649460288 | NPI | - | NPPES |
| 5010921 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5010921 (Washington) | Primary |
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