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General NPI Number Information
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NPI Number | 1699353599
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Entity Type | Organization
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Legal Business Name | HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 3022 78TH AVE SE
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2823
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Country | US
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Telephone | 206-275-3042
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 78TH AVE SE
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2823
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Country | US
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Telephone | 206-275-3042
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Fax |
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Authorized Official
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Title or Position | REG. OPS MANAGER
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Name | MARILYN CHORAK
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Credential |
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Telephone | 206-275-3042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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