| Community Health Center Of Snohomish County Lynnwood Dental | |
|
4111 194th St Sw Suite 200 Lynnwood WA 98036-4604 | |
| (425) 835-5204 | |
| (425) 835-5205 |
| Full Name | Community Health Center Of Snohomish County Lynnwood Dental |
|---|---|
| Speciality | Dentist |
| Location | 4111 194th St Sw, Lynnwood, Washington |
| Authorized Official Name and Position | Kenneth M Green (PT ACCOUNT MANAGER) |
| Authorized Official Contact | 4257893700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Health Center Of Snohomish County Lynnwood Dental Po Box 13060 Everett WA 98206-3060 Ph: (425) 789-3700 | Community Health Center Of Snohomish County Lynnwood Dental 4111 194th St Sw Suite 200 Lynnwood WA 98036-4604 Ph: (425) 835-5204 |
| NPI Number | 1114058195 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 06/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114058195 | NPI | - | NPPES |
| 8934243 | Other | WA | CRIME VICTIMS COMPENSATIO |
| 32770 | Other | WA | WORKMEN COMPENSATION |
| 5010921 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7034036 (Washington) | Primary |
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