# GATEWAY FAMILY DENTISTRY AT MILL CREEK

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

## Provider details

- **NPI number:** 1275785719
- **Authorized official:** DR. ROGER ALLEN FLAKE DDS (OWNER/ SOLE PROPRIETOR)
- **Authorized official phone:** (425) 338-2966

## Contact information

- **Practice address:** 13416 BOTHELL EVERETT HWY, SUITE 207, MILL CREEK, WA 98012-5311
- **Practice address phone:** (425) 338-2966
- **Mailing address:** 13416 BOTHELL EVERETT HWY, SUITE 207, MILL CREEK, WA 98012-5311
- **Mailing address phone:** (425) 338-2966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 6701 | WA | Yes |

## Other

- **Enumeration date:** 10/15/2008
- **Last updated:** 10/15/2008