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General NPI Number Information
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NPI Number | 1750313086
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Entity Type | Organization
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Legal Business Name | SAMMAMISH FAMILY DENTAL
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22840 NE 8TH ST STE. 101
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City | SAMMAMISH
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State | WA
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Zip | 98074-7262
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Country | US
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Telephone | 425-898-0400
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Fax | 425-898-1705
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Provider Business Mailing Address
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Address Line | 22840 NE 8TH ST STE. 101
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City | SAMMAMISH
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State | WA
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Zip | 98074-7262
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Country | US
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Telephone | 425-898-0400
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Fax | 425-898-1705
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ROBERT LYNN HUMBLE
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Credential | D.D.S.
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Telephone | 425-898-0400
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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 | 7429
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License Number State | WA
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