Chc of Snohomish County 112th Dental

NPI #1649460288 in Everett, Washington

Provider Information

NPI Number: 1649460288
Entity Type: Organization
Organization Name: Chc of Snohomish County 112th Dental
Primary Specialty: Dentist
Enumeration Date: Jul 30, 2007
Last Updated: Jul 30, 2007

Practice Location

Address: 1019 112TH ST SW
City: Everett
State: Washington
ZIP Code: 98204
Phone: (425) 551-6001

Authorized Official

Name: MR. KENNETH M GREEN
Title: EXECUTIVE DIRECTOR
Phone: (425) 789-3700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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