Provider Demographics
NPI:1114439452
Name:ACCESS DENTAL LLC
Entity type:Organization
Organization Name:ACCESS DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-878-8002
Mailing Address - Street 1:2417 PACIFIC AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2052
Mailing Address - Country:US
Mailing Address - Phone:360-878-8002
Mailing Address - Fax:360-878-8186
Practice Address - Street 1:2417 PACIFIC AVE SE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2052
Practice Address - Country:US
Practice Address - Phone:360-878-8002
Practice Address - Fax:360-878-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty