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NPI Code Detail

MEDICARE: CONCEPT DENTURE CLINIC LLC

MEDICARE: CONCEPT DENTURE CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265519516
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONCEPT DENTURE CLINIC LLC
Provider Business Mailing Address
First Line : 2027 196TH ST SW
Second Line : R1
City : LYNNWOOD
State : WA
Zip : 98036-7073
Country : US
Telephone Number : 425-697-3907
Fax Number :
Provider Business Practice Location Address
First Line : 2027 196TH ST SW
Second Line : R1
City : LYNNWOOD
State : WA
Zip : 98036-7073
Country : US
Telephone Number : 425-697-3907
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : SHAWNA ZOMBOR
Credential :
Telephone Number : 425-697-3907
Provider Enumeration Date : 11/01/2006
Last Update Date : 10/10/2009

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Directions to “CONCEPT DENTURE CLINIC LLC ” Practice Location

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