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1105 12th Ave Nw Ste #a-1a Issaquah WA 98027-8986 | |
| (425) 391-0700 | |
| (425) 391-3332 |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 1105 12th Ave Nw, Issaquah, Washington |
| Authorized Official Name and Position | Kristi Rose Donley (MANAGER) |
| Authorized Official Contact | 4253910700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1105 12th Ave Nw Ste #a-1a Issaquah WA 98027-8986 Ph: (425) 391-0700 | 1105 12th Ave Nw Ste #a-1a Issaquah WA 98027-8986 Ph: (425) 391-0700 |
| NPI Number | 1659724292 |
|---|---|
| Provider Enumeration Date | 07/19/2016 |
| Last Update Date | 07/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659724292 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | DE00010021 (Washington) | Primary |
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