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General NPI Number Information
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NPI Number | 1306923560
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Entity Type | Organization
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Legal Business Name | LYNNWOOD DENTAL EXCELLENCE DDS MSD PS INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 4202 198TH ST SW SUITE #3
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City | LYNNWOOD
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State | WA
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Zip | 98036-6730
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Country | US
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Telephone | 425-775-0651
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Fax | 425-771-5085
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Provider Business Mailing Address
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Address Line | 4202 198TH ST SW SUITE #3
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City | LYNNWOOD
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State | WA
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Zip | 98036-6730
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Country | US
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Telephone | 425-775-0651
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Fax | 425-771-5085
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DIANE E CLEMENS
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Credential |
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Telephone | 425-775-0654
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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 | 7993
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License Number State | WA
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