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General NPI Number Information
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NPI Number | 1891128468
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Entity Type | Organization
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Legal Business Name | COLUMBIA CITY DENTAL
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Dates
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Enumeration Date | 08/18/2013
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Last Update Date | 08/18/2013
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Provider Practice Location Address
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Address Line | 3810 S FERDINAND ST STE 201
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City | SEATTLE
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State | WA
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Zip | 98118-1750
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Country | US
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Telephone | 206-743-8356
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Fax | 206-829-8961
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Provider Business Mailing Address
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Address Line | 3810 S FERDINAND ST STE 201
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City | SEATTLE
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State | WA
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Zip | 98118-1750
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Country | US
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Telephone | 206-743-8356
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Fax | 206-829-8961
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEGHAN ZOE CRAWFORD
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Credential | DDS
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Telephone | 206-790-0678
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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 | DE60102882
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License Number State | WA
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