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10025 19th Ave Se Ste 200 Everett WA 98208-4275 | |
| (425) 337-6885 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10025 19th Ave Se Ste 200, Everett, 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 |
|---|---|
10025 19th Ave Se Ste 200 Everett WA 98208-4275 Ph: (425) 337-6885 | 10025 19th Ave Se Ste 200 Everett WA 98208-4275 Ph: (425) 337-6885 |
| NPI Number | 1467946376 |
|---|---|
| Provider Enumeration Date | 06/15/2018 |
| Last Update Date | 09/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467946376 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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