Organization
HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Active
Other names
Eastside Pediatric Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
LANETTE MCINTOSH AO (REGIONAL OPERATIONS MANAGER)
(425) 396-1011
Entity
Organization
Contact information
Practice address
185 NE GILMAN BLVD, ISSAQUAH, WA 98027-2937
(425) 392-4048
(425) 557-1138
Mailing address
185 NE GILMAN BLVD, ISSAQUAH, WA 98027-2937
(425) 392-4048
(425) 557-1138
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
6870
WA
1223P0221X
Pediatric Dentistry
Primary
6912
WA
1223P0221X
Pediatric Dentistry
8235
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5017967
—
WA
Enumeration date
10/01/2009
Last updated
02/25/2021
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