| Madison Wellness Center Dental | |
|
905 Spruce St Ste 300 Seattle WA 98104-2474 | |
| (206) 548-3114 | |
| (206) 762-6355 |
| Full Name | Madison Wellness Center Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 905 Spruce St Ste 300, Seattle, Washington |
| Authorized Official Name and Position | Mark Secord (PROVIDER ENROLLMENT SPECIALIST) |
| Authorized Official Contact | 2065483114 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Wellness Center Dental 3429 45th Ave Sw Seattle WA 98116-3330 Ph: (206) 933-7842 | Madison Wellness Center Dental 905 Spruce St Ste 300 Seattle WA 98104-2474 Ph: (206) 548-3114 |
| NPI Number | 1750635397 |
|---|---|
| Provider Enumeration Date | 11/05/2012 |
| Last Update Date | 11/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750635397 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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