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General NPI Number Information
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NPI Number | 1407574791
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Entity Type | Organization
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Legal Business Name | PACIFIC TELEDENTISTRY
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 2025 FAIRVIEW AVE E UNIT H
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City | SEATTLE
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State | WA
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Zip | 98102-3575
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Country | US
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Telephone | 425-238-5161
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 FAIRVIEW AVE E UNIT H
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City | SEATTLE
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State | WA
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Zip | 98102-3575
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Country | US
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Telephone | 425-238-5161
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | BRENDAN LOPEZ
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Credential |
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Telephone | 425-238-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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