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Organization
J.B. GWAK, DDS, PLLC
Active
Organization
J.B. GWAK, DDS, PLLC
Active
Other names
Snohomish Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JI WON GWAK DDS (DOCTOR/OWNER)
(310) 890-6457
Entity
Organization
Contact information
Practice address
306 MAPLE AVE, SNOHOMISH, WA 98290-2526
(310) 890-6457
(360) 568-4170
Mailing address
306 MAPLE AVE, SNOHOMISH, WA 98290-2526
(310) 890-6457
(360) 568-4170
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
604312870
UBI
WA
Enumeration date
11/26/2018
Last updated
11/26/2018
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