Healthcare Provider Details

I. General information

NPI: 1639448459
Provider Name (Legal Business Name): SUSAN D LABOUNTY DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15613 BEL RED RD BLDG B STE C
BELLEVUE WA
98008-2348
US

IV. Provider business mailing address

15613 BEL RED RD BLDG B STE C
BELLEVUE WA
98008-2348
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-7560
  • Fax: 425-869-7699
Mailing address:
  • Phone: 425-869-7560
  • Fax: 425-869-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE0006423
License Number StateWA

VIII. Authorized Official

Name: DR. SUSAN DAWN LABOUNTY
Title or Position: MANAGER
Credential: DDS
Phone: 425-869-7560