# SILVER FALLS DERMATOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pacific Dermatology and Cosmetic Center, FRONTIER DERMATOLOGY, Reichel Dermatology Associates, PLLC, Pacific Dermatology Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417163635
- **Authorized official:** MALISSA KOBBEVIK (CREDENTIALING MANAGER)
- **Authorized official phone:** (360) 375-2038

## Contact information

- **Practice address:** 11011 MERIDIAN AVE N, SUITE 102, SEATTLE, WA 98133-8967
- **Practice address phone:** (206) 859-5777
- **Practice address fax:** (206) 859-5776
- **Mailing address:** PO BOX 741825, LOS ANGELES, CA 90074-1825
- **Mailing address phone:** (206) 859-5777
- **Mailing address fax:** (206) 859-5776

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | NULL | — |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | — | — |
| 207NS0135X | Procedural Dermatology Physician | — | NULL | — |
| 207NS0135X | Procedural Dermatology Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | MD00042289 | WA | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 10/17/2024