Organization
FRED EBSWORTH DDS PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES F EBSWORTH DDS (PRESIDENT)
(206) 362-0152
Entity
Organization
Contact information
Practice address
17191 BOTHELL WAY NE, SUITE 201, LAKE FOREST PARK, WA 98155-5534
(206) 362-0152
(206) 365-3441
Mailing address
17191 BOTHELL WAY NE, SUITE 201, LAKE FOREST PARK, WA 98155-5534
(206) 362-0152
(206) 365-3441
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DE00004073
WA
Other
Enumeration date
12/09/2008
Last updated
12/09/2008
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