Provider Demographics
NPI:1417505454
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:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-233-0971
Mailing Address - Street 1:2743 CALIFORNIA AVE SW UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2495
Mailing Address - Country:US
Mailing Address - Phone:206-935-2414
Mailing Address - Fax:
Practice Address - Street 1:2743 CALIFORNIA AVE SW UNIT 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2495
Practice Address - Country:US
Practice Address - Phone:206-935-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-03
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty