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NPI Code Detail

MEDICARE: WASHINGTON DENTAL CORPORATION, PC

MEDICARE: WASHINGTON DENTAL CORPORATION, PC
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

General Provider Information

NPI Number : 1619635877
Entity Type Code : Organization
Provider Name (Legal Business Name) : WASHINGTON DENTAL CORPORATION, PC
Provider Business Mailing Address
First Line : 17000 RED HILL AVE
Second Line :
City : IRVINE
State : CA
Zip : 92614-5626
Country : US
Telephone Number : 714-845-8890
Fax Number : 303-952-0892
Provider Business Practice Location Address
First Line : 4722 FAUNTLEROY WAY SW STE A
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4667
Country : US
Telephone Number : 206-928-6242
Fax Number : 206-973-8794
Authorized Official
Title or Position : OWNER
Name : KIMBERLY BOLAK
Credential : DDS
Telephone Number : 206-928-6242
Provider Enumeration Date : 12/06/2021
Last Update Date : 12/06/2021

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Directions to “WASHINGTON DENTAL CORPORATION, PC ” Practice Location

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