MEDICARE: HOUSE, LEE, MAST, MCDONALD AND NELSON, 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
1	1223P0221X	Pediatric Dentistry

Other Identifiers

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

General Provider Information

NPI Number	:	1881241826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE, LEE, MAST, MCDONALD AND NELSON, PC

Provider Business Mailing Address
First Line	:	2617 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-2404
Country	:	US
Telephone Number	:	206-933-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	2617 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-2404
Country	:	US
Telephone Number	:	206-933-5437
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL OPERATIONS MANAGER
Name	:	LANETTE MCINTOSH
Credential	:
Telephone Number	:	425-396-1011

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	12/30/2020

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