Organization
NORTHWEST FAMILY DENTAL CARE COVINGTON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE S HAWKEN (BUSINESS MANAGER)
(253) 981-4950
Entity
Organization
Contact information
Practice address
27081 185TH AVE SE # B-105, COVINGTON, WA 98042-8448
(253) 981-4950
Mailing address
27081 185TH AVE SE # B-105, COVINGTON, WA 98042-8448
(253) 981-4950
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5267
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5267
DENTAL
WA
Enumeration date
06/29/2011
Last updated
06/29/2011
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