Organization
FALL CITY DENTAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREG M FAWCETT DDS (DENTIST OWNER PRESIDENT)
(425) 222-7011
Entity
Organization
Contact information
Practice address
33609 REDMOND-FALL CITY RD, FALL CITY, WA 98024
(425) 222-7011
(425) 222-9574
Mailing address
PO BOX 1029, FALL CITY, WA 98024
(425) 222-7011
(425) 222-9574
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00005563
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
215712215712
PREMERA BLUE CROSS
WA
01
—
674169
UNITED CONCORDIA INC
WA
01
—
FA1504
REGENCE INS
WA
Enumeration date
08/13/2006
Last updated
08/22/2020
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