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General NPI Number Information
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NPI Number | 1659597474
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Entity Type | Organization
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Legal Business Name | AESTHETIC DENTAL CENTER
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 9800 NE 120TH PL STE D
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City | KIRKLAND
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State | WA
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Zip | 98034-4220
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Country | US
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Telephone | 425-825-0626
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Fax | 425-823-9654
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Provider Business Mailing Address
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Address Line | 9800 NE 120TH PL STE D
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City | KIRKLAND
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State | WA
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Zip | 98034-4220
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Country | US
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Telephone | 425-825-0626
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Fax | 425-823-9654
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | RENE YOSHIZAWA
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Credential | MHSA
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Telephone | 425-825-0626
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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 | DE8729
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License Number State | WA
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