# LAKESIDE ENDODONTICS

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

## Provider details

- **NPI number:** 1104056910
- **Authorized official:** DR. SHAHIN ETEMADI D.D.S., M.S.D. (PRESIDENT)
- **Authorized official phone:** (425) 357-8747

## Contact information

- **Practice address:** 10025 19TH AVE SE STE 202, EVERETT, WA 98208-4275
- **Practice address phone:** (425) 357-8747
- **Practice address fax:** (425) 337-6190
- **Mailing address:** 10025 19TH AVE SE STE 202, EVERETT, WA 98208-4275
- **Mailing address phone:** (425) 357-8747
- **Mailing address fax:** (425) 337-6190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | — | Yes |

## Other

- **Enumeration date:** 07/15/2009
- **Last updated:** 04/14/2026