# FIRCREST FAMILY DENTAL

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

## Provider details

- **NPI number:** 1376010652
- **Authorized official:** NARI LEE (OFFICE MANAGER)
- **Authorized official phone:** (253) 292-0596

## Contact information

- **Practice address:** 4040 ORCHARD ST W STE 200, FIRCREST, WA 98466-6615
- **Practice address phone:** (253) 292-0596
- **Mailing address:** 3670 BRIDGEPORT WAY W UNIT B, UNIVERSITY PLACE, WA 98466-4413
- **Mailing address phone:** (253) 212-3430

## Taxonomy

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

## Other

- **Enumeration date:** 10/25/2018
- **Last updated:** 10/25/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1023163425 | — | WA |