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General NPI Number Information
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NPI Number | 1033347950
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Entity Type | Organization
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Legal Business Name | HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 9720 SANDIFUR PKWY
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City | PASCO
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State | WA
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Zip | 99301-9068
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Country | US
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Telephone | 509-543-4948
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Fax | 509-543-6940
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Provider Business Mailing Address
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Address Line | 9720 SANDIFUR PKWY
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City | PASCO
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State | WA
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Zip | 99301-9068
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Country | US
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Telephone | 509-543-4948
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Fax | 509-543-6940
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | LANETTE MCINTOSH
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Credential |
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Telephone | 425-233-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60203055
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE60203055
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60203055
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License Number State | WA
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