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General NPI Number Information
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NPI Number | 1821495466
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Entity Type | Organization
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Legal Business Name | LYNNWOOD DENTAL CARE
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 18623 HIGHWAY 99 STE 210
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City | LYNNWOOD
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State | WA
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Zip | 98037-4552
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Country | US
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Telephone | 425-412-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 18623 HIGHWAY 99 STE 210
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City | LYNNWOOD
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State | WA
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Zip | 98037-4552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | YONG PARK
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Credential |
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Telephone | 425-412-3113
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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 | DE0009186
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License Number State | WA
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