# GREEN LAKE ORAL & FACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GREEN LAKE ORAL & FACIAL SURGERY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457008435
- **Legal business name:** GREEN LAKE ORAL & FACIAL SURGERY
- **Authorized official:** DR. MATTHEW SHANE EPSTEIN (OWNER/PROVIDER)
- **Authorized official phone:** (206) 641-7212

## Contact information

- **Practice address:** 15823 WESTMINSTER WAY N, SHORELINE, WA 98133
- **Practice address phone:** (206) 848-5788
- **Practice address fax:** (206) 734-3747
- **Mailing address:** 7900 E GREEN LAKE DR N, SUITE 302, SEATTLE, WA 98103
- **Mailing address phone:** (360) 391-7872
- **Mailing address fax:** (206) 734-3211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |

## Other

- **Enumeration date:** 03/09/2022
- **Last updated:** 03/09/2022