# AJ GOLLOFON DDS PS

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

## Provider details

- **NPI number:** 1548716343
- **Authorized official:** AJ GOLLOFON (PRESIDENT)
- **Authorized official phone:** (206) 363-7200

## Contact information

- **Practice address:** 11285 LAKE CITY WAY NE, SEATTLE, WA 98125
- **Practice address phone:** (206) 363-7200
- **Practice address fax:** (206) 367-6689
- **Mailing address:** 11285 LAKE CITY WAY NE, SEATTLE, WA 98125-6718
- **Mailing address phone:** (206) 363-7200
- **Mailing address fax:** (206) 367-8869

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DE00006208 | WA | Yes |

## Other

- **Enumeration date:** 08/31/2016
- **Last updated:** 08/31/2016