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General NPI Number Information
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NPI Number | 1790018976
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Entity Type | Organization
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Legal Business Name | SOUTH SEATTLE DENTAL
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Dates
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Enumeration Date | 09/06/2009
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Last Update Date | 09/06/2009
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Provider Practice Location Address
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Address Line | 12616 RENTON AVE S
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City | SEATTLE
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State | WA
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Zip | 98178-3711
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Country | US
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Telephone | 206-772-6068
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Fax | 206-772-1231
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Provider Business Mailing Address
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Address Line | 12616 RENTON AVE S
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City | SEATTLE
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State | WA
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Zip | 98178-3711
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Country | US
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Telephone | 206-772-6068
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Fax | 206-772-1231
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Authorized Official
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Title or Position | OWNER
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Name | DR. HARRY LAU
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Credential |
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Telephone | 206-772-6068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE00010347
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License Number State | WA
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