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General NPI Number Information
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NPI Number | 1841202009
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Entity Type | Organization
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Legal Business Name | FALL CITY DENTAL CLINIC INC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 33609 REDMOND-FALL CITY RD
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City | FALL CITY
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State | WA
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Zip | 98024
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Country | US
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Telephone | 425-222-7011
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Fax | 425-222-9574
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Provider Business Mailing Address
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Address Line | PO BOX 1029
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City | FALL CITY
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State | WA
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Zip | 98024
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Country | US
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Telephone | 425-222-7011
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Fax | 425-222-9574
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Authorized Official
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Title or Position | DENTIST OWNER PRESIDENT
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Name | DR. GREG M FAWCETT
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Credential | DDS
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Telephone | 425-222-7011
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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 | DE00005563
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License Number State | WA
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