| Dental Clinic | |
|
510 19th Ave E Suite 150 Seattle WA 98112 | |
| (206) 299-1611 | |
| (206) 299-1920 |
| Full Name | Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 510 19th Ave E, Seattle, Washington |
| Authorized Official Name and Position | Angie Treptow (INTERIM DIRECTOR OF FINANCE) |
| Authorized Official Contact | 2062991937 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Clinic 2101 E Yesler Way Suite 210 Seattle WA 98122-5959 Ph: (206) 709-7112 | Dental Clinic 510 19th Ave E Suite 150 Seattle WA 98112 Ph: (206) 299-1611 |
| NPI Number | 1952883993 |
|---|---|
| Provider Enumeration Date | 09/06/2018 |
| Last Update Date | 05/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952883993 | NPI | - | NPPES |
| 2113770 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Washington) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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