# SOUTH LAKE FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1275942518
- **Authorized official:** DR. TODD MIESEL DDS (OWNER)
- **Authorized official phone:** (425) 334-9600

## Contact information

- **Practice address:** 10515 20TH ST SE, SUITE 201, LAKE STEVENS, WA 98258-4764
- **Practice address phone:** (425) 334-9600
- **Practice address fax:** (425) 334-9900
- **Mailing address:** 10515 20TH ST SE, SUITE 201, LAKE STEVENS, WA 98258-4764
- **Mailing address phone:** (425) 334-9600
- **Mailing address fax:** (425) 334-9900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7981 | WA | Yes |

## Other

- **Enumeration date:** 08/12/2014
- **Last updated:** 08/12/2014