Healthcare Provider Details

I. General information

NPI: 1629381348
Provider Name (Legal Business Name): GOOD DENTAL & DENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20015 HIGHWAY 99 STE D
LYNNWOOD WA
98036-6073
US

IV. Provider business mailing address

20015 HIGHWAY 99 STE D
LYNNWOOD WA
98036-6073
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-8590
  • Fax: 425-774-8509
Mailing address:
  • Phone: 425-774-8590
  • Fax: 425-774-8509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000454
License Number StateWA

VIII. Authorized Official

Name: JAY CHOI
Title or Position: OWNER
Credential:
Phone: 425-774-8590