Healthcare Provider Details

I. General information

NPI: 1861040800
Provider Name (Legal Business Name): HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 DUVALL AVE NE STE 230
RENTON WA
98059-4675
US

IV. Provider business mailing address

451 DUVALL AVE NE STE 230
RENTON WA
98059-4675
US

V. Phone/Fax

Practice location:
  • Phone: 425-430-8844
  • Fax: 425-430-8845
Mailing address:
  • Phone: 425-430-8844
  • Fax: 425-430-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LANETTE MCINTOSH
Title or Position: REGIONAL OPERATIONS MANAGER
Credential:
Phone: 425-396-1011