Organization
CHC OF SNOHOMISH COUNTY 112TH DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH M GREEN (EXECUTIVE DIRECTOR)
(425) 789-3700
Entity
Organization
Contact information
Practice address
1019 112TH ST SW, EVERETT, WA 98204
(425) 551-6001
(425) 551-6008
Mailing address
PO BOX 13060, EVERETT, WA 98206-3060
(425) 789-3700
(425) 789-3754
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5010921
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5010921
—
WA
Enumeration date
07/30/2007
Last updated
07/30/2007
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