Provider Demographics
NPI:1063657393
Name:HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Entity type:Organization
Organization Name:HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LA NETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:425-396-1011
Mailing Address - Street 1:2150 112TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2939
Mailing Address - Country:US
Mailing Address - Phone:425-455-0784
Mailing Address - Fax:425-451-3999
Practice Address - Street 1:2150 112TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2939
Practice Address - Country:US
Practice Address - Phone:425-455-0784
Practice Address - Fax:425-451-3999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-16
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty