Mountlake Family Dentistry
Dentist, General Practice in Mountlake Terrace, WA. Organization (NPI-2).
NPI number1164042040
StatusActive
Last updated in NPPESApr 21, 2020
Details
- NPI
- 1164042040
- Entity type
- Organization (NPI-2)
- Legal business name
- Mountlake Family Dentistry
- Organization subpart
- No
- Enumeration date
- Apr 21, 2020
- Certification date
- Apr 21, 2020
- Last updated
- Apr 21, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
22725 44th Ave W Ste 100Mountlake Terrace, WA 98043-4583
Phone 425-412-3955
Mailing address
22725 44th Ave W Ste 100Mountlake Terrace, WA 98043-4583
Phone 425-412-3955
Authorized official
Alysha Maes
Office Manager
4254123955
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