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General NPI Number Information
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NPI Number | 1417506486
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Entity Type | Organization
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Legal Business Name | WASHINGTON DENTAL FEDERAL WAY, LLC
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 31515 PETE VON REICHBAUER WAY S UNIT 108
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5599
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Country | US
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Telephone | 206-592-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 ORCHARD ST W STE 200
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City | FIRCREST
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State | WA
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Zip | 98466-6615
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Country | US
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Telephone | 253-393-2700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YONG PARK
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Credential |
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Telephone | 206-592-2442
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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 |
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License Number State |
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