Provider Demographics
NPI:1306923560
Name:LYNNWOOD DENTAL EXCELLENCE DDS MSD PS INC
Entity type:Organization
Organization Name:LYNNWOOD DENTAL EXCELLENCE DDS MSD PS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-775-0654
Mailing Address - Street 1:4202 198TH ST SW
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6730
Mailing Address - Country:US
Mailing Address - Phone:425-775-0651
Mailing Address - Fax:425-771-5085
Practice Address - Street 1:4202 198TH ST SW
Practice Address - Street 2:SUITE #3
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6730
Practice Address - Country:US
Practice Address - Phone:425-775-0651
Practice Address - Fax:425-771-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA79931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty