MEDICARE: NORTH CREEK DENTAL CARE

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	1223G0001X	General Practice Dentistry	6865	WA

General Provider Information

NPI Number	:	1669926515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CREEK DENTAL CARE

Provider Business Mailing Address
First Line	:	12806 3RD AVE SE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6455
Country	:	US
Telephone Number	:	425-338-0666
Fax Number	:	425-337-6570

Provider Business Practice Location Address
First Line	:	12806 3RD AVE SE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6455
Country	:	US
Telephone Number	:	425-338-0666
Fax Number	:	425-337-6570

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONALD ANDREW KOONTZ
Credential	:	DDS
Telephone Number	:	425-338-0666

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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Directions to “NORTH CREEK DENTAL CARE ” Practice Location

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