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General NPI Number Information
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NPI Number | 1699917302
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Entity Type | Organization
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Legal Business Name | EVERETT MALL WAY DENTAL GROUP
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 20 SW EVERETT MALL WAY SUITE 1
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City | EVERETT
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State | WA
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Zip | 98204-2700
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Country | US
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Telephone | 425-353-6254
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Fax | 425-353-6271
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Provider Business Mailing Address
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Address Line | 20 SW EVERETT MALL WAY SUITE 1
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City | EVERETT
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State | WA
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Zip | 98204-2700
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Country | US
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Telephone | 425-353-6254
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Fax | 425-353-6271
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS F HELBERT
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Credential | DDS
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Telephone | 425-353-6254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D00007661
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License Number State | WA
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