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Organization
ETHERIDGE FAMILY DENTISTRY
Active
Organization
ETHERIDGE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LIU (OFFICE MANAGER)
(206) 323-0990
Entity
Organization
Contact information
Practice address
3130 E MADISON ST STE 103, SEATTLE, WA 98112-4221
(206) 323-0990
Mailing address
3130 E MADISON ST STE 103, SEATTLE, WA 98112-4221
(206) 323-0990
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
NULL
1223E0200X
Endodontics
Primary
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
NULL
1223P0700X
Prosthodontics
—
—
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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