# ETHERIDGE FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093147068
- **Authorized official:** LORI LIU (OFFICE MANAGER)
- **Authorized official phone:** (206) 323-0990

## Contact information

- **Practice address:** 3130 E MADISON ST STE 103, SEATTLE, WA 98112-4221
- **Practice address phone:** (206) 323-0990
- **Mailing address:** 3130 E MADISON ST STE 103, SEATTLE, WA 98112-4221
- **Mailing address phone:** (206) 323-0990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | Yes |
| 1223E0200X | Endodontics | — | — | Yes |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | NULL | — |
| 1223P0700X | Prosthodontics | — | — | — |

## Other

- **Enumeration date:** 08/01/2013
- **Last updated:** 08/01/2013