Healthcare Provider Details

I. General information

NPI: 1639395122
Provider Name (Legal Business Name): CLEMENT & TEEL PS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 NE 125TH ST SUITE 2
SEATTLE WA
98125-8911
US

IV. Provider business mailing address

3340 NE 125TH ST SUITE 2
SEATTLE WA
98125-8911
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-6696
  • Fax: 206-363-0072
Mailing address:
  • Phone: 206-363-6696
  • Fax: 206-363-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00006440
License Number StateWA

VIII. Authorized Official

Name: DR. NANCY J TEEL
Title or Position: DENTIST
Credential: DDS
Phone: 206-363-6696