| Green Leaf Kids | |
|
4219 S Othello St Ste 105d Seattle WA 98118-3873 | |
| (206) 316-2351 | |
| Not Available |
| Full Name | Green Leaf Kids |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4219 S Othello St Ste 105d, Seattle, Washington |
| Authorized Official Name and Position | Yonatan Nir Ahdut (DENTIST/OWNER) |
| Authorized Official Contact | 2534265821 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Leaf Kids 4219 S Othello St Ste 105d Seattle WA 98118-3873 Ph: (206) 316-2351 | Green Leaf Kids 4219 S Othello St Ste 105d Seattle WA 98118-3873 Ph: (206) 316-2351 |
| NPI Number | 1881189322 |
|---|---|
| Provider Enumeration Date | 06/27/2018 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881189322 | NPI | - | NPPES |
| 2036949 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE60479557 (Washington) | Primary |
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