# MOUNTLAKE FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1164042040
- **Authorized official:** ALYSHA MAES (OFFICE MANAGER)
- **Authorized official phone:** (425) 412-3955

## Contact information

- **Practice address:** 22725 44TH AVE W STE 100, MOUNTLAKE TERRACE, WA 98043-4583
- **Practice address phone:** (425) 412-3955
- **Mailing address:** 22725 44TH AVE W STE 100, MOUNTLAKE TERRACE, WA 98043-4583
- **Mailing address phone:** (425) 412-3955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2020
- **Last updated:** 04/21/2020