| Crystal Dental Inc | |
|
12644 164th Ave Se Renton WA 98059-6403 | |
| (425) 282-4182 | |
| Not Available |
| Full Name | Crystal Dental Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12644 164th Ave Se, Renton, Washington |
| Authorized Official Name and Position | Michael Sungyun Cho (SOLE MEMBER) |
| Authorized Official Contact | 9093626319 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Dental Inc 2740 118th Ave Se Apt 102 Bellevue WA 98005-8130 Ph: (909) 362-6319 | Crystal Dental Inc 12644 164th Ave Se Renton WA 98059-6403 Ph: (425) 282-4182 |
| NPI Number | 1689166084 |
|---|---|
| Provider Enumeration Date | 05/31/2018 |
| Last Update Date | 05/31/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689166084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE60603860 (Washington) | Primary |
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