| South Lake Family Dentistry | |
|
10515 20th St Se Suite 201 Lake Stevens WA 98258-4764 | |
| (425) 334-9600 | |
| (425) 334-9900 |
| Full Name | South Lake Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 10515 20th St Se, Lake Stevens, Washington |
| Authorized Official Name and Position | Todd Miesel (OWNER) |
| Authorized Official Contact | 4253349600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Lake Family Dentistry 10515 20th St Se Suite 201 Lake Stevens WA 98258-4764 Ph: (425) 334-9600 | South Lake Family Dentistry 10515 20th St Se Suite 201 Lake Stevens WA 98258-4764 Ph: (425) 334-9600 |
| NPI Number | 1275942518 |
|---|---|
| Provider Enumeration Date | 08/12/2014 |
| Last Update Date | 08/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275942518 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7981 (Washington) | Primary |
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