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2722 Colby Ave Suite 318 Everett WA 98201-3557 | |
(425) 551-1000 | |
(425) 551-1001 |
Full Name | |
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Speciality | Dentist |
Location | 2722 Colby Ave, 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 |
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Po Box 13060 Everett WA 98206-3060 Ph: (425) 789-3700 | 2722 Colby Ave Suite 318 Everett WA 98201-3557 Ph: (425) 551-1000 |
NPI Number | 1164553137 |
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Provider Enumeration Date | 03/08/2007 |
Last Update Date | 06/13/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164553137 | NPI | - | NPPES |
5010921 | Medicaid | WA | |
8934243 | Other | WA | CRIME VICTIM COMPENSATION |
32770 | Other | WA | WORKMEN COMPENSATION |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 5010921 (Washington) | Primary |
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