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General NPI Number Information
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NPI Number | 1164039731
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Entity Type | Organization
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Legal Business Name | CONSOLIDATED DENTAL THREE
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 19221 108TH AVE SE STE 2
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City | RENTON
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State | WA
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Zip | 98055-7369
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Country | US
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Telephone | 425-988-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 19221 108TH AVE SE STE 2
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City | RENTON
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State | WA
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Zip | 98055-7369
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | CHELSEA D'NICHOLE MORTELL
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Credential | DMD
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Telephone | 206-787-0132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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