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General NPI Number Information
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NPI Number | 1962729889
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Entity Type | Organization
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Legal Business Name | PAMELA N SURSELY DDS, PLLC
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Dates
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Enumeration Date | 05/02/2010
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Last Update Date | 05/02/2010
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Provider Practice Location Address
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Address Line | 12911 120TH AVE NE STE F200
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City | KIRKLAND
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State | WA
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Zip | 98034-3026
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Country | US
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Telephone | 425-821-9111
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Fax | 425-821-2696
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Provider Business Mailing Address
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Address Line | 12911 120TH AVE NE STE F200
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City | KIRKLAND
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State | WA
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Zip | 98034-3026
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Country | US
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Telephone | 425-821-9111
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Fax | 425-821-2696
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PAMELA N SURSELY
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Credential | DDS
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Telephone | 425-985-0442
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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 | DE60122941
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License Number State | WA
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