MEDICARE: DR GARRICK J LO DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	122300000X	Dentist

General Provider Information

NPI Number	:	1023262623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR GARRICK J LO DDS PLLC

Provider Business Mailing Address
First Line	:	8435 161ST AVE NE
Second Line	:	SUITE 102
City	:	REDMOND
State	:	WA
Zip	:	98052-1512
Country	:	US
Telephone Number	:	425-885-1151
Fax Number	:	425-883-0386

Provider Business Practice Location Address
First Line	:	8435 161ST AVE NE
Second Line	:	SUITE 102
City	:	REDMOND
State	:	WA
Zip	:	98052-1512
Country	:	US
Telephone Number	:	425-885-1151
Fax Number	:	425-883-0386

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARRICK J LO
Credential	:	DDS
Telephone Number	:	206-851-8421

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	09/27/2023

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