MEDICARE: DOCARE DENTAL CORP.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223G0001X	General Practice Dentistry
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
3	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1356764633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCARE DENTAL CORP.

Provider Business Mailing Address
First Line	:	6720 FORT DENT WAY STE 120
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2580
Country	:	US
Telephone Number	:	206-242-4121
Fax Number	:	206-242-4113

Provider Business Practice Location Address
First Line	:	6720 FORT DENT WAY STE 120
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2580
Country	:	US
Telephone Number	:	206-242-4121
Fax Number	:	206-242-4113

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFF LEIPHAM
Credential	:
Telephone Number	:	425-736-5521

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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1992288674 — AMERICAN CURRENT CARE OF WASHINGTON, P.S.
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Directions to “DOCARE DENTAL CORP. ” Practice Location

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