| South Seattle Dental | |
|
12616 Renton Ave S Seattle WA 98178-3711 | |
| (206) 772-6068 | |
| (206) 772-1231 |
| Full Name | South Seattle Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12616 Renton Ave S, Seattle, Washington |
| Authorized Official Name and Position | Harry Lau (OWNER) |
| Authorized Official Contact | 2067726068 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Seattle Dental 12616 Renton Ave S Seattle WA 98178-3711 Ph: (206) 772-6068 | South Seattle Dental 12616 Renton Ave S Seattle WA 98178-3711 Ph: (206) 772-6068 |
| NPI Number | 1790018976 |
|---|---|
| Provider Enumeration Date | 09/06/2009 |
| Last Update Date | 09/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790018976 | NPI | - | NPPES |
| 5054291 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE00010347 (Washington) | Primary |
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