Healthcare Provider Details

I. General information

NPI: 1003243205
Provider Name (Legal Business Name): GILE, NOV, FERNYOUGH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LENORA ST SUITE 216
SEATTLE WA
98121-2720
US

IV. Provider business mailing address

900 LENORA ST SUITE 216
SEATTLE WA
98121-2720
US

V. Phone/Fax

Practice location:
  • Phone: 206-402-5490
  • Fax:
Mailing address:
  • Phone: 206-402-5490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7263
License Number StateWA

VIII. Authorized Official

Name: MIKE GILE
Title or Position: MEMBER
Credential: DDS
Phone: 425-747-9141