# FALL CITY DENTAL CLINIC INC

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

## Provider details

- **NPI number:** 1841202009
- **Authorized official:** DR. GREG M FAWCETT DDS (DENTIST OWNER PRESIDENT)
- **Authorized official phone:** (425) 222-7011

## Contact information

- **Practice address:** 33609 REDMOND-FALL CITY RD, FALL CITY, WA 98024
- **Practice address phone:** (425) 222-7011
- **Practice address fax:** (425) 222-9574
- **Mailing address:** PO BOX 1029, FALL CITY, WA 98024
- **Mailing address phone:** (425) 222-7011
- **Mailing address fax:** (425) 222-9574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE00005563 | WA | Yes |

## Other

- **Enumeration date:** 08/13/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 215712215712 | PREMERA BLUE CROSS | WA |
| 01 | — | 674169 | UNITED CONCORDIA INC | WA |
| 01 | — | FA1504 | REGENCE INS | WA |