Healthcare Provider Details

I. General information

NPI: 1033347950
Provider Name (Legal Business Name): HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 SANDIFUR PKWY
PASCO WA
99301-9068
US

IV. Provider business mailing address

9720 SANDIFUR PKWY
PASCO WA
99301-9068
US

V. Phone/Fax

Practice location:
  • Phone: 509-543-4948
  • Fax: 509-543-6940
Mailing address:
  • Phone: 509-543-4948
  • Fax: 509-543-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60203055
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE60203055
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE60203055
License Number StateWA

VIII. Authorized Official

Name: LANETTE MCINTOSH
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 425-233-0971