Organization
PACIFIC TELEDENTISTRY
Active
Organization
PACIFIC TELEDENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDAN LOPEZ (FOUNDER)
(425) 238-5161
Entity
Organization
Contact information
Practice address
2025 FAIRVIEW AVE E UNIT H, SEATTLE, WA 98102-3575
(425) 238-5161
Mailing address
2025 FAIRVIEW AVE E UNIT H, SEATTLE, WA 98102-3575
(425) 238-5161
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WDLL7R80J93B
DRIVING LICENSE
WA
Enumeration date
08/22/2022
Last updated
08/22/2022
Update your record
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