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General NPI Number Information
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NPI Number | 1174046049
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Entity Type | Organization
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Legal Business Name | GREAT NORTHWEST DENTAL
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 1346 8TH ST NE STE 100
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City | AUBURN
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State | WA
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Zip | 98002-4588
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Country | US
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Telephone | 253-833-6033
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Fax | 253-833-6033
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Provider Business Mailing Address
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Address Line | 806 195TH AVE E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-5614
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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 | DENTIST/OWNER
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Name | LINDSEY PAPAC
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Credential | DDS
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Telephone | 253-833-6033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60099970
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License Number State | WA
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