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23805 Highway 99 Ste 100 Edmonds WA 98026-9204 | |
(425) 778-6333 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 23805 Highway 99 Ste 100, Edmonds, Washington |
Authorized Official Name and Position | Tabatha Lemke (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 2175406078 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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23805 Highway 99 Ste 100 Edmonds WA 98026-9204 Ph: () - | 23805 Highway 99 Ste 100 Edmonds WA 98026-9204 Ph: (425) 778-6333 |
NPI Number | 1760033807 |
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Provider Enumeration Date | 09/20/2019 |
Last Update Date | 11/20/2020 |
Identifier | Type | State | Issuer |
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1760033807 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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