MEDICARE: APPLE PEDIATRIC DENTISTRY

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
1	122300000X	Dentist	DE00009470	WA
2	1223P0221X	Pediatric Dentistry	DE00009470	WA

General Provider Information

NPI Number	:	1275858029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	2141 WASHINGTON ST STE 102
Second Line	:
City	:	FERNDALE
State	:	WA
Zip	:	98248-9183
Country	:	US
Telephone Number	:	360-389-3198
Fax Number	:	866-501-0671

Provider Business Practice Location Address
First Line	:	3100 SQUALICUM PKWY STE 103
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1936
Country	:	US
Telephone Number	:	360-389-3198
Fax Number	:	866-501-0671

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MATTHEW YEH
Credential	:
Telephone Number	:	360-389-3198

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	06/11/2020

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Directions to “APPLE PEDIATRIC DENTISTRY ” Practice Location

Language	Start Address	Practice Location

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