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10627 19th Ave Se Ste A Everett WA 98208-5147 | |
| (818) 744-1473 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 10627 19th Ave Se Ste A, Everett, Washington |
| Authorized Official Name and Position | Daniel Gedalia (MANAGER) |
| Authorized Official Contact | 8187441473 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10627 19th Ave Se Ste A Everett WA 98208-5147 Ph: (818) 744-1473 | 10627 19th Ave Se Ste A Everett WA 98208-5147 Ph: (818) 744-1473 |
| NPI Number | 1396427456 |
|---|---|
| Provider Enumeration Date | 08/07/2023 |
| Last Update Date | 10/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396427456 | NPI | - | NPPES |
| 1720513096 | Other | WA | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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