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11120 Evergreen Way Suite G Everett WA 98204 | |
| (425) 265-1188 | |
| (425) 265-1619 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11120 Evergreen Way, Everett, Washington |
| Authorized Official Name and Position | Young Bae Park (DENTIST/PRESIDENT) |
| Authorized Official Contact | 4252651188 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11120 Evergreen Way Suit G Everett WA 98204 Ph: (425) 265-1188 | 11120 Evergreen Way Suite G Everett WA 98204 Ph: (425) 265-1188 |
| NPI Number | 1487979092 |
|---|---|
| Provider Enumeration Date | 04/07/2010 |
| Last Update Date | 04/07/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487979092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE7465 (Washington) | Primary |
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